Synergy to reduce emergency department visits for uncontrolled hyperglycemia

Diabetes Educ. May-Jun 2013;39(3):354-64. doi: 10.1177/0145721713484593. Epub 2013 Apr 22.

Abstract

Purpose: The purpose of this pilot study was to evaluate the safety and preliminary efficacy of a treatment algorithm and education intervention for the management of patients with type 2 diabetes and hyperglycemia presenting to the emergency department (ED) and stable enough to be discharged home.

Methods: Urban hospital ED patients (n = 86) with BG ≥ 200 mg/dL were enrolled in a 4-week prospective, nonrandomized pilot intervention with historic self-controls. Follow-up visits occurred at 12 to 72 hours, 2 and 4 weeks, and 6 months. T2DM medications were initiated or adjusted at each visit using a guideline-based diabetes medication management algorithm. Survival skills diabetes self-management education and navigation to outpatient services were provided.

Results: Participants were 51.8% male and 92% black, and 87.3% had private or public insurance. The top reasons for presenting to the ED were no provider appointment available (41.7%) and no primary care provider (14.6%). No hypoglycemia occurred in the first 24 hours following ED T2DM medication initiation or titration and overall hypoglycemia rates were low. BG was reduced from 356 ± 110 mg/dL at baseline to 183 ± 103 mg/dL at 4 weeks (P < .001).

Conclusion: Diabetes medication management and survival skills education for uncontrolled diabetes may be safely initiated in the ED, as demonstrated by the multidisciplinary STEP-DC intervention, which effectively enabled glycemic control in this pilot study.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Blood Glucose / drug effects*
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / epidemiology
  • District of Columbia / epidemiology
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data*
  • Feasibility Studies
  • Female
  • Humans
  • Hyperglycemia / drug therapy*
  • Hyperglycemia / economics
  • Hyperglycemia / epidemiology
  • Hypoglycemic Agents / therapeutic use*
  • Insulin / therapeutic use*
  • Male
  • Middle Aged
  • Patient Discharge
  • Patient Education as Topic
  • Pilot Projects
  • Practice Guidelines as Topic
  • Prospective Studies
  • Self Care* / methods
  • Urban Population

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin