Stop Emergency Room Visits for Hyperglycemia Project - District of Columbia (DC) (STEP-DC)

MedStar Health

Status: Completed

Conditions: Type 2 Diabetes Mellitus

Treatments: Drug: Antihyperglycemic medication guideline for management of uncontrolled hyperglycemia presenting to the ED using metformin, sulfonylurea and/or insulin; Behavioral: Diabetes survival skills self-management education

Study type: Interventional

Funder types: Other

Identifiers

NCT01033773

2007-268

Details and patient eligibility

About

To demonstrate that a focused Emergency Department (ED) intervention for uncontrolled hyperglycemia enables safe and effective glycemic management and reduces emergency room re-visits. We assessed hypoglycemia BG < 60mg/dL; change in mean blood glucose and A1C, and ED revisits for hyperglycemia.

Full description

Patients with BG > 200mg/dL presenting to an urban tertiary care hospital ED were enrolled in a 4 week prospective intervention with historic self-controls. Subjects returned at 12-72 hours, 2 and 4 weeks. Diabetes medications (including sulfonylureas, metformin and/or insulin) were initiated and/or adjusted at each visit using the intervention algorithm per presenting blood glucose and prior diabetes medications. Survival skills self-management education and navigation to outpatient services were provided.

Enrollment: 86 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age > 18 years
• Type 2 Diabetes Mellitus,
• random BG > 200 mg/dL,
• willing and able to provide informed consent and to participate in diabetes self-management education (DSME)
• stable for discharge from the ED once hyperglycemia treatment initiated.

Exclusion criteria

• type 1 Diabetes Mellitus,
• diabetic ketoacidosis or hyperosmolar non-ketotic state,
• concomitant treatment with glucocorticoids (other than stable maintenance dose therapy),
• cognitive or physical impairment preventing participation in DSME
• unwillingness or inability to provide consent and/or attend follow-up visits.

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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86 participants in 1 patient group

Diabetes education and medication management

Other group

Description:

All enrolled patients received the intervention. There was no comparative arm. The analysis was done as pre and post.

Treatment:

Behavioral: Diabetes survival skills self-management education

Drug: Antihyperglycemic medication guideline for management of uncontrolled hyperglycemia presenting to the ED using metformin, sulfonylurea and/or insulin