Impact of a Subcutaneous Insulin Protocol in the Emergency Department: Rush Emergency Department Hyperglycemia Intervention (REDHI)

Autor: Grace Villanueva, Katherine Hannold, Christina Munoz, Louis Fogg, David S. Baldwin, Tricia J. Johnson, Janyce Cagan Agruss
Rok vydání: 2011
Předmět:
Zdroj: The Journal of Emergency Medicine. 40:493-498
ISSN: 0736-4679
DOI: 10.1016/j.jemermed.2008.03.017
Popis: We evaluated a hyperglycemia treatment protocol for use in the Emergency Department (ED) in patients with diabetes mellitus (DM) before admission to the hospital or discharge home.Fifty-four consecutive patients with a history of DM and an ED admission blood glucose (BG)200 mg/dL were treated with subcutaneous (SQ) insulin aspart every 2 h until BG was200 mg/dL. Point-of-care BG was measured immediately on ED admission and every 2 h until discharge home or hospital admission. The intervention group was compared with 54 historical controls with DM and an ED admission BG200 mg/dL.One hundred percent of intervention patients received insulin aspart, whereas only 35% of historical controls received insulin therapy. In the intervention group, mean BG declined from 333 ± 104 mg/dL on ED admission to 158 ± 68 mg/dL on ED discharge. In the historical control group, mean BG decline was significantly less, from 322 ± 126 mg/dL on admission to 242 ± 79 mg/dL on discharge (p0.001). Sixty-nine percent of intervention patients and 67% of controls were subsequently admitted to the hospital. Mean hospital length of stay (LOS) in the intervention group was significantly less, 3.8 ± 3.3 days, compared with 5.3 ± 4.1 days in the control group (p0.05). Four intervention patients (7.4%) developed a BG70 mg/dL.A protocol for the treatment of acute hyperglycemia in the ED can be safely implemented. Subsequent inpatient LOS was reduced. Further randomized clinical trials of this intervention are warranted.
Databáze: OpenAIRE
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