Currently submitted to: JMIR Diabetes
Date Submitted: Jul 21, 2026
Open Peer Review Period: Jul 29, 2026 - Sep 23, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
EHR Alert-Driven Rapid HbA1c Testing Risk-stratifies Severe Type 2 Diabetes in the Emergency Department
ABSTRACT
Background:
Hyperglycemia is common in adults presenting to the ED. Most, but not all, have known Type 2 Diabetes (T2D), and the underlying severity of their T2D is often unassessed. A fast-turnaround HbA1c blood test can risk-stratify patients, and this study assessed the impact of an electronic health record (EHR) alert prompting HbA1c testing in the ED among patients with severe hyperglycemia with and without known T2D.
Objective:
This prospective observational study evaluated the performance of the EHR alert and characterized HbA1c levels among patients with severe hyperglycemia.
Methods:
This was a prospective, observational study evaluating the design and performance of an EHR alert that prompted a rapid HbA1c test when a random glucose level exceeded 250 mg/dL. The alert was active for one year, starting in March 2025, at a single academic center, and the primary outcomes were the mean HbA1c among patients with ‘new-onset T2D’, ‘known T2D without complications’, ‘known T2D with complications’, and ‘other diagnoses’, as well as ED disposition.
Results:
There were 1,632 EHR actions included in the analysis, resulting in 606 rapid HbA1c orders (37.1%) and an overall average HbA1c of 9.4%. There were higher HbA1c levels for ‘new-onset T2D’ (10.2%) and for ‘known T2D without complications’ (10.7%), compared to ‘known T2D with complications’ (9.4%) and ‘other diagnoses’ (8.9%), p < 0.001. Clinicians tended to order more HbA1c tests for ‘new-onset T2D’ and ‘known T2D without complications’. These two groups also had significantly higher rates of discharge, 80% and 59.8%, respectively, compared to known T2D with complications (29.6%) and other diagnoses (32.1%), p < 0.001. Conclusion: EHR alert-driven HbA1c testing showed that patients with ‘new-onset T2D’ and ‘known T2D without complications’ have severe underlying diabetes (HbA1c > 10%) and are usually discharged.
Conclusions:
EHR alert-driven HbA1c testing showed that patients with ‘new-onset T2D’ and ‘known T2D without complications’ have severe underlying diabetes (HbA1c > 10%) and are usually discharged. Clinical Trial: N/A
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