title: THE SYNERGY TO ENABLE GLYCEMIC CONTROL FOLLOWING EMERGENCY DEPARTMENT DISCHARGE PROGRAM FOR ADULTS WITH TYPE 2 DIABETES: STEP-DIABETES.
abstract: OBJECTIVE
  To evaluate a diabetes (DM) care delivery model among hyperglycemic adults with type 2 DM being discharged from the emergency department (ED) to home. The primary hypothesis was that a focused education and medication management intervention would lead to a greater short-term improvement in glycemic control compared to controls.
  
  
  METHODS
  A 4-week, randomized controlled trial provided antihyperglycemic medications management using an evidence-based algorithm plus survival skills diabetes self-management education (DSME) for ED patients with blood glucose (BG) levels ≥200 mg/dL. The intervention was delivered by endocrinologist-supervised certified diabetes educators. Controls received usual ED care.
  
  
  RESULTS
  Among 101 participants (96% Black, 54% female, 62.3% Medicaid and/or Medicare insurance), 77% completed the week 4 visit. Glycated hemoglobin A1C (A1C) went from 11.8 ± 2.4 to 10.5 ± 1.9% (P<.001) and 11.5 ± 2.0 to 11.1 ± 2.1% in the intervention and control groups, respectively (P = .012). At 4 weeks, the difference in A1C reduction between groups was 0.9% (P = .01). Mean BG decreased for both groups (P<.001), with a higher percentage of intervention patients (65%) reaching a BG <180 mg/dL compared to 29% of controls (P = .002). Hypoglycemia rates did not differ by group, and no severe hypoglycemia was reported. Medication adherence (Modified Morisky Score(©)) improved from low to medium (P<.001) among intervention patients and did not improve among controls.
  
  
  CONCLUSIONS
  This study provides evidence that a focused diabetes care delivery intervention can be initiated in the ED among adults with type 2 diabetes and hyperglycemia and safely and effectively completed in the ambulatory setting. Improvement in short-term glycemic outcomes and medication adherence were observed.
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Magee
authors.forename: Carine M
authors.initials: CM
authors.lastname: Nassar
authors.forename: Mihriye
authors.initials: M
authors.lastname: Mete
authors.forename: Keyoana
authors.initials: K
authors.lastname: White
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Youssef
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Dubin
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods / Q000458:organization & administration; D001786:Blood Glucose / Q000378:metabolism*; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards; D010353:Patient Education as Topic / Q000379:methods / Q000458:organization & administration; D012648:Self Care / Q000379:methods / Q000592:standards
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents