Diabetes Education May Cut ED Return Visits

The mean blood glucose level at study entry was 356 mg/dL, with one patient having a level of 923 mg/dL that was treated with an insulin drip. The mean baseline HbA_1c was 12%. However, that is probably an underestimate because the A1cNow point of care device used in the study has an upper limit of 13% and half of the patients had an HbA_1c of greater than 13%, she said.

A total of 60% of the patients completed all four visits, 21% completed two or three, and 19% did not return for any visits after the initial one in the ED. Nearly half (48%) had seen a primary care physician or were scheduled to see one as a result of the intervention.

Among the 60 patients who completed at least three visits, there were no instances of hypoglycemia (blood glucose level of 60 mg/dL or below) on day 1, and the overall hypoglycemia rate was just 1.33% of total patient-days, representing a total of 26 hypoglycemic events over 1,956 patient days. There were no episodes of severe hypoglycemia, defined as a glucose level of 40 mg/dL or less or any event requiring assistance to treat, Dr. Magee reported.

Mean blood glucose level fell by 173 mg/dL, to 183 mg/dL from the baseline 356 mg/dL. Mean HbA_1c fell by 0.4 percentage points, to 11.6%. However, again, this is likely an underestimate, she noted.

Visits to the ED for hypo- or hyperglycemia were cut by 78%, from 42 in the 6 months prior to the intervention to just 9 in the subsequent 6 months. This was a strong trend, but the sample size was too small to reach statistical significance.

On average, the CDE spent about 6 hours per patient to complete all the visits, and the supervising physician spent about 30 minutes total. The average cost of staff time per patient was about $350, compared with an average $678 for an ED visit for uncontrolled blood sugar.