Synergy to reduce emergency department visits for uncontrolled hyperglycemia.
Synergy to reduce emergency department visits for uncontrolled hyperglycemia.
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
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. 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. 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. 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).
English
0145-7217
*Blood Glucose/de [Drug Effects]
*Diabetes Mellitus, Type 2/dt [Drug Therapy]
*Emergency Service, Hospital/ut [Utilization]
*Hyperglycemia/dt [Drug Therapy]
*Hypoglycemic Agents/tu [Therapeutic Use]
*Insulin/tu [Therapeutic Use]
*Self Care
Adolescent
Adult
Algorithms
Diabetes Mellitus, Type 2/ec [Economics]
Diabetes Mellitus, Type 2/ep [Epidemiology]
District of Columbia/ep [Epidemiology]
Emergency Service, Hospital/ec [Economics]
Feasibility Studies
Female
Humans
Hyperglycemia/ec [Economics]
Hyperglycemia/ep [Epidemiology]
Male
Middle Aged
Patient Discharge
Patient Education as Topic
Pilot Projects
Practice Guidelines as Topic
Prospective Studies
Self Care/mt [Methods]
Urban Population
MedStar Diabetes Institute
MedStar Health Research Institute
MedStar Washington Hospital Center
Emergency Medicine
Medicine/Endocrinology
MedStar Diabetes Institute
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
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. 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. 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. 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).
English
0145-7217
*Blood Glucose/de [Drug Effects]
*Diabetes Mellitus, Type 2/dt [Drug Therapy]
*Emergency Service, Hospital/ut [Utilization]
*Hyperglycemia/dt [Drug Therapy]
*Hypoglycemic Agents/tu [Therapeutic Use]
*Insulin/tu [Therapeutic Use]
*Self Care
Adolescent
Adult
Algorithms
Diabetes Mellitus, Type 2/ec [Economics]
Diabetes Mellitus, Type 2/ep [Epidemiology]
District of Columbia/ep [Epidemiology]
Emergency Service, Hospital/ec [Economics]
Feasibility Studies
Female
Humans
Hyperglycemia/ec [Economics]
Hyperglycemia/ep [Epidemiology]
Male
Middle Aged
Patient Discharge
Patient Education as Topic
Pilot Projects
Practice Guidelines as Topic
Prospective Studies
Self Care/mt [Methods]
Urban Population
MedStar Diabetes Institute
MedStar Health Research Institute
MedStar Washington Hospital Center
Emergency Medicine
Medicine/Endocrinology
MedStar Diabetes Institute
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't