Abstract
BackgroundUncomplicated hyperglycaemia is a common presentation in the emergency department (ED). Rapid glucose control is associated with the risk of iatrogenic hypoglycaemia. We sought to determine the safety of a rapid glucose control protocol delivered in a 24-h emergency department observation unit (OU).MethodsThis is a retrospective chart review of patients admitted to the OU for hyperglycaemia where the assessing clinician deemed there was no other reason for medical admission apart from hyperglycaemia; and that the patient could be safely discharged provided their hyperglycaemia was adequately treated. The rapid glucose control protocol consists of 4–6 hourly glucose monitoring and insulin injections according to a sliding scale. We report the demographics, reduction in glucose values and the incidence of hypoglycaemia in the OU. We also determine the rate of discharge from OU and the rate of hospital admission at 30 days.ResultsWe included 101 patients. The mean age was 53.5 years (95% CI 50.4–56.6) and 64% of patients were male. The mean HbA1c value was 12.8% (95% CI 12.3–13.3). The mean admission and discharge glucose values were 27.2 (95% CI 26.3–28.1) and 13.9 (95% CI 13.2–14.6) mmols/l respectively. There was no incidence of hypoglycaemia in the OU. We successfully discharged 90.1% of the patients from the OU, of which 3 (3.3%) patients were admitted to the hospital within 30 days of discharge.ConclusionED OU is a safe location to deliver effective management for patients presented with uncomplicated severe hyperglycaemia.
Highlights
Uncomplicated hyperglycaemia is a common presentation in the emergency department (ED)
We focused on patients for whom the assessing clinician deemed that there was no other reason for medical admission apart from hyperglycaemia; and who it was felt could be safely discharged provided their hyperglycaemia was adequately treated
During the 19-month period, 101 patients were admitted to the observation unit (OU) for hyperglycaemia
Summary
Uncomplicated hyperglycaemia is a common presentation in the emergency department (ED). Rapid glucose control is associated with the risk of iatrogenic hypoglycaemia. We sought to determine the safety of a rapid glucose control protocol delivered in a 24-h emergency department observation unit (OU). Hyperglycaemia contributes as high as 20% of patients presenting to the Emergency Department (ED) [1]. Patients with hyperglycaemia would be admitted to the ward, resulting in an average ward length stay of 2–5 days [6]. Ibrahim et al BMC Emergency Medicine (2021) 21:66 They would have received glucose control and diabetes education during the stay. A recent study showed that patients with hyperglycaemia presented at the ED could be discharged directly from the ED with a modest glucose control (blood glucose at discharge of 17.6–18.6 mmol/L) [5]. Another study showed < 1% incidence of iatrogenic hypoglycaemia with less stringent glucose control (blood glucose at discharge of 19.4–33.3 mmol/L) [8]
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