Stop Emergency Room Visits for Hyperglycemia Project - District of Columbia (DC)

Medstar Health Research Institute86 enrolled

Overview

To demonstrate that a focused Emergency Department (ED) intervention for uncontrolled hyperglycemia enables safe and effective glycemic management and reduces emergency room re-visits. We assessed hypoglycemia BG \< 60mg/dL; change in mean blood glucose and A1C, and ED revisits for hyperglycemia.

Patients with BG \> 200mg/dL presenting to an urban tertiary care hospital ED were enrolled in a 4 week prospective intervention with historic self-controls. Subjects returned at 12-72 hours, 2 and 4 weeks. Diabetes medications (including sulfonylureas, metformin and/or insulin) were initiated and/or adjusted at each visit using the intervention algorithm per presenting blood glucose and prior diabetes medications. Survival skills self-management education and navigation to outpatient services were provided.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Type 2 Diabetes Mellitus

Interventions

Antihyperglycemic medication guideline for management of uncontrolled hyperglycemia presenting to the ED using metformin, sulfonylurea and/or insulinDRUG

Diabetes medications (including sulfonylureas, metformin and/or insulin) were initiated and/or adjusted at each visit using the intervention algorithm per presenting blood glucose and prior diabetes medications.

Diabetes survival skills self-management educationBEHAVIORAL

Survival skills DSME based upon current JCAHO and ADA joint recommendations for persons with diabetes prior to discharge to the outpatient setting was initiated in the ED and continued at the follow-up encounters.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age \> 18 years * Type 2 Diabetes Mellitus, * random BG \> 200 mg/dL, * willing and able to provide informed consent and to participate in diabetes self-management education (DSME) * stable for discharge from the ED once hyperglycemia treatment initiated. Exclusion Criteria: * type 1 Diabetes Mellitus, * diabetic ketoacidosis or hyperosmolar non-ketotic state, * concomitant treatment with glucocorticoids (other than stable maintenance dose therapy), * cognitive or physical impairment preventing participation in DSME * unwillingness or inability to provide consent and/or attend follow-up visits.

Locations (1)

Washington Hospital Center

Washington D.C., District of Columbia, United States

Outcomes

Primary Outcomes

Total Number of Hypoglycemia Events (Blood Glucose < 60mg/dL) Within 24 Hours of Baseline Visit

Total Number of hypoglycemic events defined as Blood Glucose \< 60 within 24 hours of index emergency room visit (baseline)

Time frame: 24 hours

Secondary Outcomes

Change in Mean Blood Glucose From Time of Presentation to Emergency Room to End of Intervention 30 Days From Baseline

Mean difference in of blood glucose in mg/dl between baseline mean BG and end of intervention mean BG 30 days from baseline

Time frame: 30 days

Change in Hemoglobin A1C From Baseline to End of Intervention at 30 Days

difference between mean hemoglobin A1C at baseline and mean Hemoglobin A1C to end of intervention

Time frame: 30 days

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.