THE SYNERGY TO ENABLE GLYCEMIC CONTROL FOLLOWING EMERGENCY DEPARTMENT DISCHARGE PROGRAM FOR ADULTS WITH TYPE 2 DIABETES: STEP-DIABETES. 

 -  2015 
<br/><br/> 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. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1530-891X 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Blood Glucose/me [Metabolism]<br/>*Continuity of Patient Care<br/>*Diabetes Mellitus, Type 2/bl [Blood]<br/>*Diabetes Mellitus, Type 2/th [Therapy]<br/>*Emergency Service, Hospital<br/>*Patient Discharge<br/>*Patient Education as Topic<br/>Adult<br/>Behavior Therapy/mt [Methods]<br/>Behavior Therapy/og [Organization & Administration]<br/>Continuity of Patient Care/og [Organization & Administration]<br/>Continuity of Patient Care/st [Standards]<br/>Emergency Service, Hospital/og [Organization & Administration]<br/>Female<br/>Hemoglobin A, Glycosylated/an [Analysis]<br/>Humans<br/>Hypoglycemic Agents/ad [Administration & Dosage]<br/>Male<br/>Middle Aged<br/>Patient Discharge/st [Standards]<br/>Patient Education as Topic/mt [Methods]<br/>Patient Education as Topic/og [Organization & Administration]<br/>Self Care/mt [Methods]<br/>Self Care/st [Standards]
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Health Research Institute<br/>MedStar Washington Hospital Center<br/>MedStar Washington Hospital Center<br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Emergency Medicine<br/>Medicine/Endocrinology<br/>MedStar Diabetes Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Randomized Controlled Trial<br/>Research Support, Non-U.S. Gov't