TY  - BOOK
AU  - Dubin, Jeffrey S
AU  - Fokar, Ali
AU  - Magee, Michelle F
AU  - Nassar, Carine M
AU  - Sharretts, John M
AU  - Smith, Mark S
TI  - Synergy to reduce emergency department visits for uncontrolled hyperglycemia
SN  - 0145-7217
KW  - *Blood Glucose/de [Drug Effects]
KW  - *Diabetes Mellitus, Type 2/dt [Drug Therapy]
KW  - *Emergency Service, Hospital/ut [Utilization]
KW  - *Hyperglycemia/dt [Drug Therapy]
KW  - *Hypoglycemic Agents/tu [Therapeutic Use]
KW  - *Insulin/tu [Therapeutic Use]
KW  - *Self Care
KW  - Adolescent
KW  - Adult
KW  - Algorithms
KW  - Diabetes Mellitus, Type 2/ec [Economics]
KW  - Diabetes Mellitus, Type 2/ep [Epidemiology]
KW  - District of Columbia/ep [Epidemiology]
KW  - Emergency Service, Hospital/ec [Economics]
KW  - Feasibility Studies
KW  - Female
KW  - Humans
KW  - Hyperglycemia/ec [Economics]
KW  - Hyperglycemia/ep [Epidemiology]
KW  - Male
KW  - Middle Aged
KW  - Patient Discharge
KW  - Patient Education as Topic
KW  - Pilot Projects
KW  - Practice Guidelines as Topic
KW  - Prospective Studies
KW  - Self Care/mt [Methods]
KW  - Urban Population
KW  - MedStar Diabetes Institute
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Emergency Medicine
KW  - Medicine/Endocrinology
KW  - Evaluation Studies
KW  - Journal Article
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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)
UR  - http://dx.doi.org/10.1177/0145721713484593
ER  -