Synergy to Reduce Emergency Department Visits for Uncontrolled Hyperglycemia. (May 2013)

• Record Type: Journal Article
• Authors: Magee, Michelle F.; Nassar, Carine M.; Copeland, James; Fokar, Ali; Sharretts, John M.; Dubin, Jeffrey S.; Smith, Mark S.
• Is Part Of: Diabetes educator. Volume 39:Number 3(2013)
• Page Start: 354
• Page End: 364
• Publication Date: 2013-05
• Subjects: Diabetes -- Study and teaching -- Periodicals; 616.462005
• DOI: 10.1177/0145721713484593
• Languages: English
• ISSNs: 0145-7217

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. 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. 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). 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.