title: Limited communication and management of emergency department hyperglycemia in hospitalized patients.
abstract: BACKGROUND
  Hyperglycemia is often overlooked and unaddressed in hospitalized patients, and early and intensive management may improve outcomes.
  
  
  OBJECTIVE
  To evaluate communication and early management of emergency department (ED) hyperglycemia.
  
  
  METHODS
  This was a retrospective cohort study of patients with an initial serum glucose >or=140 mg/dL at an urban, academic institution. We randomly selected cases from a consecutive sample of ED visits with at least 1 serum glucose result during a 1-year period. We recorded clinical data and compared the content of inpatient and ED-written discharge instructions.
  
  
  RESULTS
  Of the 27,688 initial ED glucose results during the study period, 3517 (13%) were 140-199 mg/dL, and 2304 (8%) values were >or=200 mg/dL. In our sample of 385 patients, 293 (76%) patients were hospitalized. Inpatient or ED discharge instructions informed 36 (10%) patients of their hyperglycemia and 23 (6%) of a plan for further evaluation and management. There was no difference between inpatient and ED instructions for either of these variables (P = 0.73 and 0.16, respectively). Overall, 107 (55%) patients with glucose values 140-199 mg/dL and 31 (16%) patients with glucose >or=200 mg/dL had no prior diabetes diagnosis. Only 61 (16%) received insulin in the ED for their hyperglycemia, and hyperglycemia was charted as a diagnosis in 36 (9%) cases.
  
  
  CONCLUSIONS
  Most ED patients with even mild hyperglycemia were hospitalized. Recognition, communication, and management of ED hyperglycemia were suboptimal and represent a missed opportunity to identify undiagnosed diabetes and to initiate early glycemic control for hospitalized patients.
authors.affiliation: Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA. adit.ginde@ucdenver.edu
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.forename: Davut J
authors.initials: DJ
authors.lastname: Savaser
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003142:Communication; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012189:Retrospective Studies
chemical_list: D007328:Insulin