title: Synergy to reduce emergency department visits for uncontrolled hyperglycemia.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Medstar Diabetes and Research Institutes, Washington, DC, USA (Dr Magee, Mrs Nassar)|Washington Hospital Center, Department of Internal Medicine, Endocrinology and Metabolism Division, Washington, DC, USA (Dr Magee, Dr Sharretts)|Georgetown University School of Medicine and Healthcare Sciences, Washington, DC, USA (Dr Magee)
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Magee
authors.affiliation: Medstar Diabetes and Research Institutes, Washington, DC, USA (Dr Magee, Mrs Nassar)
authors.forename: Carine M
authors.initials: CM
authors.lastname: Nassar
authors.affiliation: District of Columbia Diabetes Prevention and Control Program, District of Columbia, Department of Health, Washington, DC, USA (Mr Copeland)
authors.forename: James
authors.initials: J
authors.lastname: Copeland
authors.affiliation: Department of Epidemiology and Biostatistics, Medstar Health Research Institute, Takoma Park, MD, USA (Mr Fokar)
authors.forename: Ali
authors.initials: A
authors.lastname: Fokar
authors.affiliation: Washington Hospital Center, Department of Internal Medicine, Endocrinology and Metabolism Division, Washington, DC, USA (Dr Magee, Dr Sharretts)
authors.forename: John M
authors.initials: JM
authors.lastname: Sharretts
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, Washington, DC, USA (Dr Dubin, Dr Smith)
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Dubin
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, Washington, DC, USA (Dr Dubin, Dr Smith)
authors.forename: Mark S
authors.initials: MS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D004219:District of Columbia / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012648:Self Care / Q000379:methods; D014505:Urban Population
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin