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Synergy to reduce emergency department visits for uncontrolled hyperglycemia.

by Magee, Michelle F; Nassar, Carine M; Fokar, Ali; Sharretts, John M; Dubin, Jeffrey S; Smith, Mark S.
Citation: Diabetes Educator. 39(3):354-64, 2013 May-Jun..Journal: The Diabetes educator.ISSN: 0145-7217.Full author list: Magee MF; Nassar CM; Copeland J; Fokar A; Sharretts JM; Dubin JS; Smith MS.UI/PMID: 23610182.Subject(s): Adolescent | Adult | Algorithms | *Blood Glucose/de [Drug Effects] | *Diabetes Mellitus, Type 2/dt [Drug Therapy] | Diabetes Mellitus, Type 2/ec [Economics] | Diabetes Mellitus, Type 2/ep [Epidemiology] | District of Columbia/ep [Epidemiology] | Emergency Service, Hospital/ec [Economics] | *Emergency Service, Hospital/ut [Utilization] | Feasibility Studies | Female | Humans | *Hyperglycemia/dt [Drug Therapy] | Hyperglycemia/ec [Economics] | Hyperglycemia/ep [Epidemiology] | *Hypoglycemic Agents/tu [Therapeutic Use] | *Insulin/tu [Therapeutic Use] | Male | Middle Aged | Patient Discharge | Patient Education as Topic | Pilot Projects | Practice Guidelines as Topic | Prospective Studies | Self Care/mt [Methods] | *Self Care | Urban PopulationInstitution(s): MedStar Diabetes Institute | MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment(s): MedStar Diabetes Institute | Medicine/Endocrinology | Emergency MedicineActivity type: Journal Article.Medline article type(s): Evaluation Studies | Journal Article | Research Support, Non-U.S. Gov'tOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1177/0145721713484593 (Click here) Abbreviated citation: Diabetes Educ. 39(3):354-64, 2013 May-Jun.Local Holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006.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.Abstract: 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.Abstract: 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).Abstract: 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.

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