Michelle F Magee1,2,3, Carine M Nassar1, James Copeland4, Ali Fokar5, John M Sharretts2, Jeffrey S Dubin6, Mark S Smith6. 1. Medstar Diabetes and Research Institutes, Washington, DC, USA (Dr Magee, Mrs Nassar) 2. Washington Hospital Center, Department of Internal Medicine, Endocrinology and Metabolism Division, Washington, DC, USA (Dr Magee, Dr Sharretts) 3. Georgetown University School of Medicine and Healthcare Sciences, Washington, DC, USA (Dr Magee) 4. District of Columbia Diabetes Prevention and Control Program, District of Columbia, Department of Health, Washington, DC, USA (Mr Copeland) 5. Department of Epidemiology and Biostatistics, Medstar Health Research Institute, Takoma Park, MD, USA (Mr Fokar) 6. Department of Emergency Medicine, Washington Hospital Center, Washington, DC, USA (Dr Dubin, Dr Smith)
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.
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.
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Authors: Michelle F Magee; Kelley M Baker; Stephen J Fernandez; Chun-Chi Huang; Mihriye Mete; Alex R Montero; Carine M Nassar; Paul A Sack; Kelly Smith; Gretchen A Youssef; Stephen R Evans Journal: BMJ Open Diabetes Res Care Date: 2019-11-13