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

Not Applicable

Completed

Interventions: Drug: Antihyperglycemic medication guideline for management of uncontrolled hyperglycemia presenting to the ED using metformin, sulfonylurea and/or insulin
Behavioral: Diabetes survival skills self-management education

Brief Summary: 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.

Detailed Description: 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.

Recruitment & Eligibility

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.

Arm && Interventions

Group	Intervention	Description
Diabetes education and medication management	Diabetes survival skills self-management education	All enrolled patients received the intervention. There was no comparative arm. The analysis was done as pre and post.
Diabetes education and medication management	Antihyperglycemic medication guideline for management of uncontrolled hyperglycemia presenting to the ED using metformin, sulfonylurea and/or insulin	All enrolled patients received the intervention. There was no comparative arm. The analysis was done as pre and post.

Primary Outcome Measures

Name	Time	Method
Total Number of Hypoglycemia Events (Blood Glucose < 60mg/dL) Within 24 Hours of Baseline Visit	24 hours	Total Number of hypoglycemic events defined as Blood Glucose \< 60 within 24 hours of index emergency room visit (baseline)

Secondary Outcome Measures

Name	Time	Method
Change in Hemoglobin A1C From Baseline to End of Intervention at 30 Days	30 days	difference between mean hemoglobin A1C at baseline and mean Hemoglobin A1C to end of intervention
Change in Mean Blood Glucose From Time of Presentation to Emergency Room to End of Intervention 30 Days From Baseline	30 days	Mean difference in of blood glucose in mg/dl between baseline mean BG and end of intervention mean BG 30 days from baseline