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

STEP-DC: Stop Emergency Room Visits for Uncontrolled Hyperglycemia Project in the District of Columbia

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.

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.

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.