Journal Article

The Synergy to Enable Glycemic Control Following Emergency Department Discharge Program for Adults with Type 2 Diabetes: Step-Diabetes

Dubin, Jeffrey S., Youssef, Gretchen A., Mete, Mihri ye, White, Keyoana, Nassar, Carine M., Magee, Michelle F.

2015

Overview

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. 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. 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. 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.

• Publisher: Elsevier Limited
• Subject: Adult / Behavior Therapy - methods / Behavior Therapy - organization & administration / Blood Glucose - metabolism / Continuity of Patient Care - organization & administration / Continuity of Patient Care - standards / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - therapy / Emergency Service, Hospital - organization & administration / Female / Glycated Hemoglobin A - analysis / Humans / Hypoglycemic Agents - administration & dosage / Male / Middle Aged / Patient Discharge - standards / Patient Education as Topic - methods / Patient Education as Topic - organization & administration / Self Care - methods / Self Care - standards