Routine glucose assessment in the emergency department for detecting unrecognised diabetes: a cluster randomised trial

To the Editor: We congratulate Cheung and colleagues1 on their large cluster randomised trial of routine blood glucose and automated glycated haemoglobin (HbA_1c) testing in emergency departments. This trial reaffirmed the high prevalence of unrecognised diabetes in patients presenting to the emergency department, while demonstrating the feasibility of algorithmic detection. However, the rate of documented follow‐up plans in patients with suspected or newly diagnosed diabetes was low and did not benefit from the trial intervention. Cheung and colleagues1 and Hare and Shaw,2 in their accompanying editorial, suggest that this may relate to diabetes services already operating at full capacity or to overburdened staff documenting abbreviated plans at discharge. The trial highlights the difficulty in improving outcomes when multiple non‐integrated health professionals manage a condition and, hence, the importance of continuity of care.