OBJECTIVE: We evaluated a hyperglycemia treatment protocol for use in the Emergency Department (ED) in patients with diabetes mellitus (DM) before admission to the hospital or discharge home. METHODS:Fifty-four consecutive patients with a history of DM and an ED admission blood glucose (BG) > 200 mg/dL were treated withsubcutaneous (SQ) insulin aspart every 2 h until BG was < 200 mg/dL. Point-of-care BG was measured immediately on ED admission and every 2 h until discharge home or hospital admission. The intervention group was compared with 54 historical controls with DM and an ED admission BG > 200 mg/dL. RESULTS: One hundred percent of intervention patients received insulin aspart, whereas only 35% of historical controls received insulin therapy. In the intervention group, mean BG declined from 333 ± 104 mg/dL on ED admission to 158 ± 68 mg/dL on ED discharge. In the historical control group, mean BG decline was significantly less, from 322 ± 126 mg/dL on admission to 242 ± 79 mg/dL on discharge (p < 0.001). Sixty-nine percent of intervention patients and 67% of controls were subsequently admitted to the hospital. Mean hospital length of stay (LOS) in the intervention group was significantly less, 3.8 ± 3.3 days, compared with 5.3 ± 4.1 days in the control group (p < 0.05). Four intervention patients (7.4%) developed a BG < 70 mg/dL. CONCLUSION: A protocol for the treatment of acute hyperglycemia in the ED can be safely implemented. Subsequent inpatient LOS was reduced. Further randomized clinical trials of this intervention are warranted.
RCT Entities:
OBJECTIVE: We evaluated a hyperglycemia treatment protocol for use in the Emergency Department (ED) in patients with diabetes mellitus (DM) before admission to the hospital or discharge home. METHODS: Fifty-four consecutive patients with a history of DM and an ED admission blood glucose (BG) > 200 mg/dL were treated with subcutaneous (SQ) insulinaspart every 2 h until BG was < 200 mg/dL. Point-of-care BG was measured immediately on ED admission and every 2 h until discharge home or hospital admission. The intervention group was compared with 54 historical controls with DM and an ED admission BG > 200 mg/dL. RESULTS: One hundred percent of intervention patients received insulinaspart, whereas only 35% of historical controls received insulin therapy. In the intervention group, mean BG declined from 333 ± 104 mg/dL on ED admission to 158 ± 68 mg/dL on ED discharge. In the historical control group, mean BG decline was significantly less, from 322 ± 126 mg/dL on admission to 242 ± 79 mg/dL on discharge (p < 0.001). Sixty-nine percent of intervention patients and 67% of controls were subsequently admitted to the hospital. Mean hospital length of stay (LOS) in the intervention group was significantly less, 3.8 ± 3.3 days, compared with 5.3 ± 4.1 days in the control group (p < 0.05). Four intervention patients (7.4%) developed a BG < 70 mg/dL. CONCLUSION: A protocol for the treatment of acute hyperglycemia in the ED can be safely implemented. Subsequent inpatient LOS was reduced. Further randomized clinical trials of this intervention are warranted.
Authors: Shelagh A Mulvaney; Shilo Anders; Annie K Smith; Eric J Pittel; Kevin B Johnson Journal: J Telemed Telecare Date: 2012-03 Impact factor: 6.184
Authors: Etie S Moghissi; Mary T Korytkowski; Monica DiNardo; Daniel Einhorn; Richard Hellman; Irl B Hirsch; Silvio E Inzucchi; Faramarz Ismail-Beigi; M Sue Kirkman; Guillermo E Umpierrez Journal: Diabetes Care Date: 2009-05-08 Impact factor: 19.112
Authors: Virginia Bellido; Lorena Suarez; Maria Galiana Rodriguez; Cecilia Sanchez; Marta Dieguez; Maria Riestra; Florentino Casal; Elias Delgado; Edelmiro Menendez; Guillermo E Umpierrez Journal: Diabetes Care Date: 2015-10-12 Impact factor: 19.112