Impact of a subcutaneous insulin protocol in the emergency department: Rush Emergency Department Hyperglycemia Intervention (REDHI)

J Emerg Med. 2011 May;40(5):493-8. doi: 10.1016/j.jemermed.2008.03.017. Epub 2008 Oct 1.


Objective: We evaluated a hyperglycemia treatment protocol for use in the Emergency Department (ED) in patients with diabetes mellitus (DM) before admission to the hospital or discharge home.

Methods: Fifty-four consecutive patients with a history of DM and an ED admission blood glucose (BG) > 200 mg/dL were treated with subcutaneous (SQ) insulin aspart every 2 h until BG was < 200 mg/dL. Point-of-care BG was measured immediately on ED admission and every 2 h until discharge home or hospital admission. The intervention group was compared with 54 historical controls with DM and an ED admission BG > 200 mg/dL.

Results: One hundred percent of intervention patients received insulin aspart, whereas only 35% of historical controls received insulin therapy. In the intervention group, mean BG declined from 333 ± 104 mg/dL on ED admission to 158 ± 68 mg/dL on ED discharge. In the historical control group, mean BG decline was significantly less, from 322 ± 126 mg/dL on admission to 242 ± 79 mg/dL on discharge (p < 0.001). Sixty-nine percent of intervention patients and 67% of controls were subsequently admitted to the hospital. Mean hospital length of stay (LOS) in the intervention group was significantly less, 3.8 ± 3.3 days, compared with 5.3 ± 4.1 days in the control group (p < 0.05). Four intervention patients (7.4%) developed a BG < 70 mg/dL.

Conclusion: A protocol for the treatment of acute hyperglycemia in the ED can be safely implemented. Subsequent inpatient LOS was reduced. Further randomized clinical trials of this intervention are warranted.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Blood Glucose / analysis
  • Chi-Square Distribution
  • Clinical Protocols
  • Diabetes Complications / drug therapy*
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Humans
  • Hyperglycemia / drug therapy*
  • Hypoglycemic Agents / administration & dosage*
  • Insulin / administration & dosage*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Pilot Projects
  • Point-of-Care Systems
  • Treatment Outcome


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin