Comparison of two glycemic discharge goals in ED patients with hyperglycemia, a randomized trial

Abstract

Study objectiveHyperglycemia is commonly encountered in the ED; the importance of glucose reduction in patients well enough to be discharged is unknown. MethodsWe conducted a prospective, randomized trial of ED patients with hyperglycemia with a glucose value 400–600 mg/dL who were discharged from the ED, excluding those with type 1 diabetes mellitus. Patients were randomly assigned to a discharge glucose goal, <350 mg/dL (moderate control) or < 600 mg/dL (loose control). The primary outcome was ED length of stay. ResultsAmong 110 enrolled patients, 57 were assigned to moderate and 53 to loose glycemic control. Median (IQR) length of stay was 211 min (177–288 min) for the moderate group and 216 min (151–269 min) for the loose group (difference, 17 min [95% CI −15 to 49 min]). ED length of stay for those with an actual discharge glucose <350 mg/dL was 29 min longer (95% CI −1 to 59 min). Repeat ED visits for hyperglycemia (7% vs 6%), hospitalization for hyperglycemia (0% vs 2%), and hospitalization for any reason (4% vs 8%) did not differ significantly between groups. ConclusionIn the intention-to-treat analysis, ED length of stay and 7-day outcomes were not significantly different whether moderate or loose glycemic control was pursued. However, the length of stay for those with discharge glucose <350 mg/dL was approximately 29 min longer. ED glycemic control did not appear to be associated negative short-term outcomes. Glucose reduction in well-appearing ED patients may consume time and resources without conferring short- or long-term benefits.Trial Registration: Clinicaltrials.govNCT02478190