TY  - BOOK
AU  - Dubin, Jeffrey S
AU  - Magee, Michelle
AU  - Mete, Mihriye
AU  - Nassar, Carine M
AU  - White, Keyoana
AU  - Youssef, Gretchen A
TI  - THE SYNERGY TO ENABLE GLYCEMIC CONTROL FOLLOWING EMERGENCY DEPARTMENT DISCHARGE PROGRAM FOR ADULTS WITH TYPE 2 DIABETES: STEP-DIABETES
SN  - 1530-891X
PY  - 2015///
KW  - *Blood Glucose/me [Metabolism]
KW  - *Continuity of Patient Care
KW  - *Diabetes Mellitus, Type 2/bl [Blood]
KW  - *Diabetes Mellitus, Type 2/th [Therapy]
KW  - *Emergency Service, Hospital
KW  - *Patient Discharge
KW  - *Patient Education as Topic
KW  - Adult
KW  - Behavior Therapy/mt [Methods]
KW  - Behavior Therapy/og [Organization & Administration]
KW  - Continuity of Patient Care/og [Organization & Administration]
KW  - Continuity of Patient Care/st [Standards]
KW  - Emergency Service, Hospital/og [Organization & Administration]
KW  - Female
KW  - Hemoglobin A, Glycosylated/an [Analysis]
KW  - Humans
KW  - Hypoglycemic Agents/ad [Administration & Dosage]
KW  - Male
KW  - Middle Aged
KW  - Patient Discharge/st [Standards]
KW  - Patient Education as Topic/mt [Methods]
KW  - Patient Education as Topic/og [Organization & Administration]
KW  - Self Care/mt [Methods]
KW  - Self Care/st [Standards]
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Emergency Medicine
KW  - Medicine/Endocrinology
KW  - MedStar Diabetes Institute
KW  - Journal Article
KW  - Randomized Controlled Trial
KW  - Research Support, Non-U.S. Gov't
N2  - CONCLUSIONS: This study provides evidence that a focused diabetes care delivery intervention can be initiated in the ED among adults with type 2 diabetes and hyperglycemia and safely and effectively completed in the ambulatory setting. Improvement in short-term glycemic outcomes and medication adherence were observed; METHODS: A 4-week, randomized controlled trial provided antihyperglycemic medications management using an evidence-based algorithm plus survival skills diabetes self-management education (DSME) for ED patients with blood glucose (BG) levels >200 mg/dL. The intervention was delivered by endocrinologist-supervised certified diabetes educators. Controls received usual ED care; OBJECTIVE: To evaluate a diabetes (DM) care delivery model among hyperglycemic adults with type 2 DM being discharged from the emergency department (ED) to home. The primary hypothesis was that a focused education and medication management intervention would lead to a greater short-term improvement in glycemic control compared to controls; RESULTS: Among 101 participants (96% Black, 54% female, 62.3% Medicaid and/or Medicare insurance), 77% completed the week 4 visit. Glycated hemoglobin A1C (A1C) went from 11.8 +/- 2.4 to 10.5 +/- 1.9% (P<.001) and 11.5 +/- 2.0 to 11.1 +/- 2.1% in the intervention and control groups, respectively (P = .012). At 4 weeks, the difference in A1C reduction between groups was 0.9% (P = .01). Mean BG decreased for both groups (P<.001), with a higher percentage of intervention patients (65%) reaching a BG <180 mg/dL compared to 29% of controls (P = .002). Hypoglycemia rates did not differ by group, and no severe hypoglycemia was reported. Medication adherence (Modified Morisky Score(©)) improved from low to medium (P<.001) among intervention patients and did not improve among controls
UR  - http://dx.doi.org/10.4158/EP15655.OR
ER  -