Abstract
BACKGROUND:
Hyperglycemia is often overlooked and unaddressed in hospitalized patients, and early and intensive management may improve outcomes.
OBJECTIVE:
To evaluate communication and early management of emergency department (ED) hyperglycemia.
METHODS:
This was a retrospective cohort study of patients with an initial serum glucose β₯140 mg/dL at an urban, academic institution. We randomly selected cases from a consecutive sample of ED visits with at least 1 serum glucose result during a 1βyear period. We recorded clinical data and compared the content of inpatient and EDβwritten discharge instructions.
RESULTS:
Of the 27,688 initial ED glucose results during the study period, 3517 (13%) were 140β199 mg/dL, and 2304 (8%) values were β₯200 mg/dL. In our sample of 385 patients, 293 (76%) patients were hospitalized. Inpatient or ED discharge instructions informed 36 (10%) patients of their hyperglycemia and 23 (6%) of a plan for further evaluation and management. There was no difference between inpatient and ED instructions for either of these variables (P = 0.73 and 0.16, respectively). Overall, 107 (55%) patients with glucose values 140β199 mg/dL and 31 (16%) patients with glucose β₯200 mg/dL had no prior diabetes diagnosis. Only 61 (16%) received insulin in the ED for their hyperglycemia, and hyperglycemia was charted as a diagnosis in 36 (9%) cases.
CONCLUSIONS:
Most ED patients with even mild hyperglycemia were hospitalized. Recognition, communication, and management of ED hyperglycemia were suboptimal and represent a missed opportunity to identify undiagnosed diabetes and to initiate early glycemic control for hospitalized patients. Journal of Hospital Medicine 2009;4:45β49. Β© 2009 Society of Hospital Medicine.