THE SYNERGY TO ENABLE GLYCEMIC CONTROL FOLLOWING EMERGENCY DEPARTMENT DISCHARGE PROGRAM FOR ADULTS WITH TYPE 2 DIABETES: STEP-DIABETES.
Citation: Endocrine Practice. 21(11):1227-39, 2015 Nov.PMID: 26214111Institution: MedStar Health Research Institute | MedStar Washington Hospital Center | MedStar Washington Hospital Center | MedStar Washington Hospital CenterDepartment: Emergency Medicine | Medicine/Endocrinology | MedStar Diabetes InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Randomized Controlled Trial | Research Support, Non-U.S. Gov'tSubject headings: *Blood Glucose/me [Metabolism] | *Continuity of Patient Care | *Diabetes Mellitus, Type 2/bl [Blood] | *Diabetes Mellitus, Type 2/th [Therapy] | *Emergency Service, Hospital | *Patient Discharge | *Patient Education as Topic | Adult | Behavior Therapy/mt [Methods] | Behavior Therapy/og [Organization & Administration] | Continuity of Patient Care/og [Organization & Administration] | Continuity of Patient Care/st [Standards] | Emergency Service, Hospital/og [Organization & Administration] | Female | Hemoglobin A, Glycosylated/an [Analysis] | Humans | Hypoglycemic Agents/ad [Administration & Dosage] | Male | Middle Aged | Patient Discharge/st [Standards] | Patient Education as Topic/mt [Methods] | Patient Education as Topic/og [Organization & Administration] | Self Care/mt [Methods] | Self Care/st [Standards]Year: 2015ISSN:- 1530-891X
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 26214111 | Available | 26214111 |
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.
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