Routine hemoglobin-A1c screening is required before the next pandemic to reduce morbidity and in-hospital costs

Abstract

Introduction: Glycosylated hemoglobin (HbA1c) levels are routinely used in secondary and tertiary care centers for monitoring diabetes patients. However, since it is an expensive test, it is not routinely tested in primary care or used as a screening test. This study aimed to examine the relationship between HbA1c levels and in-hospital costs in hospitalized patients during the pandemic period to draw attention to the issue and to be prepared for future pandemics.

Methodology: The design of the study was retrospective and cross-sectional. The study was conducted in a tertiary hospital between March and December 2020. Independent variables, including HbA1c levels, comorbidities, age, and gender; and dependent variables including in-hospital costs, prolonged hospital stay (≥ 14 days), and 30-day mortality; were statistically analyzed.

Results: Overall, 517 patients were included in the study, and 96 of them had high HbA1c levels (HbA1c ≥ 7). The in-hospital costs were significantly correlated with HbA1c ≥ 7 as continuous variables, and HbA1c ≥ 7 was a better indicator of in-hospital costs compared to the diagnosis of diabetes. Patients with HbA1c ≥ 7 also had prolonged hospital stays and higher mortality rates, in addition to high in-hospital costs.

Conclusions: Routine testing of HbA1c levels might be cost-effective and should be performed at primary healthcare facilities.