Management Of Diabetic Emergencies Research Articles

RF16 | PSUN204 Improving Inpatient Insulin Management amongst Internal Medicine Residents with a Multi-Media Structured Educational Program

Abstract Introduction Approximately 1 in 4 patients admitted to the hospital carry a diagnosis of diabetes mellitus1 and 1 in 10 patients are admitted due to diabetes complications.2 Although Internal Medicine residents comprise the primary care team for the vast majority of patients admitted to major academic hospitals, there is a paucity of resources and standardized training for inpatient diabetes management, specifically designed for residents. Methods We developed a structured resident education program consisting of a mobile/web application ("EndoApp") as an accessible resource combined with a series of short lectures. The EndoApp is comprised of checklists, guidelines, and calculators based on the most recent American Diabetes Association (ADA) and American Association of Family Physicians (AAFP) recommendations. The application addresses five major areas of inpatient insulin management—i) insulin pharmacokinetics, ii) admission dosage calculation, iii) inpatient insulin regimen adjustment, iv) management of diabetic emergencies, and v) equipment and prescription management at discharge. The confidence level of residents for each of the five areas were surveyed at months 0, 1, and 3, after the start of the program on a scale of 1-5. Results Our 3-month interim analysis showed that the confidence of residents in all five areas of inpatient insulin management improved over the study period. Increased confidence was seen in post-graduate year (PGY) 1, 2, and 3 residents. The Admission Insulin Dosing Calculator was the most frequently used function (45% of residents), followed by DKA/HHS helper (23% of residents), and Inpatient Dosage Adjustment Guidelines (21% of residents). Residents who used the Admission Insulin Dosing Calculator had greater increase in provider confidence compared to those who did not use the function. Subjective feedback from residents included expanding functions to include hypoglycemia and non-emergent hyperglycemia management, as well as having recordings of supplementary lectures available on the application. Conclusion Structured resident education in inpatient insulin management utilizing a mobile/web application and lectures as supplementary material is a promising approach to improve resident education and confidence in inpatient diabetes management.

Out-of-Hospital Management of Diabetic Emergencies in Germany: Structural and Process Quality

To collect and analyse representative data of structural and process quality in the management of diabetic emergencies in Germany in 2020. A standardised questionnaire comprising detailed items concerning clinically relevant parameters on the structural and process quality of out-of-hospital management of diabetic emergencies was sent nationwide to medical directors of emergency medical service districts (EMSDs). Results were compared with those from a similar study conducted in 2001. The return rate of the questionnaires represented 126 EMSDs, serving a total population of > 40.1 million. Only 4% of ambulances carried glucagon (6% in 2001). In 2020, blood glucose determination increased significantly to 71% of all emergency interventions and to 29% of suspected cardiac emergencies (24% and 15%, respectively, in 2001). In 100% of EMSDs severe hypoglycaemia (SH) was treated by paramedics by administering intravenous dextrose before the arrival of a doctor compared to 63% in 2001. The potential value of nasal glucagon was acknowledged by 43% of responders. In selected patients, treatment of SH was conducted without hospital admission in 78% of EMDs (60% in 2001). Fifty-three percent of medical directors acknowledged the need for further training in diabetic emergencies (47% in 2001). Cooperation for medical education between emergency teams and a diabetes centre was reported by 14% (41% in 2001). Structural and process quality of the management of diabetic emergencies in Germany has improved considerably since 2001. Persisting deficiencies could be improved by providing better medical equipment in ambulances and ongoing education to the entire emergency teams.

A narrative review of Diabetes mellitus: An update for dentists

Introduction: Diabetes mellitus (DM) is a common metabolic disorder and a leading cause of mortality and morbidity worldwide. Dentists are increasingly encountered with patients affected by this chronic condition. Aim: To a review on updates in DM, dental management and emergencies. Methods: Database search was carried out in PubMed and Google scholar limited to articles of English language from 1998 to 2021 and pertaining to the keywords diabetes, orofacial manifestations , dental management diabetic emergency. A narrative review of this search is presented in this article. Results and Discussion: This article gives a concise update on DM and discuss the management of diabetic patients in a dental setting. Conclusion: Discussion of the possible orofacial manifestations of DM and management of diabetic emergencies is emphasized for efficicient dental practice.

Level of knowledge and evaluation of perceptions regarding pediatric diabetes among Greek teachers

AimTo assess the knowledge and attitudes of nursery school, preschool and primary school Greek teachers regarding pediatric diabetes. MethodsOur anonymous questionnaire was comprised of three parts: the first part was regarding sociodemographic characteristics; the second part was assessing basic knowledge about diabetes and the third part was about personal perceptions regarding diabetes management in the school setting. A total of 375 fully completed questionnaires were collected (22.67% from males). ResultsMales had a higher percentage of correct answers than females (80.71 ± 10.58% versus 80.17 ± 11.77%), but without reaching statistical significance (p = 0.763). Teachers aged over 45 years, tertiary education graduates and teachers in the public sector proved to be more knowledgeable about the disease. Question scoring the lowest percentage of correct answers were those dealing with the management of diabetic emergencies, such as the course of action in case a diabetic pupil is found unconscious. One out of four participants incorrectly declared that a delay in the diagnosis of diabetes mellitus cannot possibly be life-threatening whereas, an embarrassing 7.47% of the participants stated that diabetes is a contagious disease and another 6.67% declared that diabetic children should stop school. ConclusionsIt is evident that there is an urgent need for providing further information, as well as practical training to schoolteachers with emphasis being placed on the initial symptoms of diabetes and also in the detection and management of diabetic emergencies.

Self-reported, House-Officer's Competency and Knowledge

This study was conducted to assess the competency of fresh medical graduates in dealing with common emergency conditions. Graduates who received structured training in Emergency Medicine (EM) as part of their medical school curriculum (stratified group) were compared to those who did not (pooled group). Curricula of medical schools were reviewed. Structured questionnaire was used to collect data which included self-reported competencies and demographics among the medical graduates. The study population were 162 freshly graduated doctors, among them 35 received structured training in EM. Lack of competency in clinical skills ranged from 2.9% - 40% and 11.4% - 53% among stratified and pooled groups respectively. We found a statistically significant difference in skills related to assessment of acutely ill patient, use of ABCDE approach, valve mask ventilation, dysphagia screening, management of diabetic emergencies, and management of convulsions. A relatively higher level of competency was reported in those who received structured training in emergency medicine. Incorporation of emergency medicine in the curricula might improve the competency of junior doctors.

Management of diabetes in police custody: a liaison initiative between a diabetes specialist service and the police force

AbstractThe management of people with diabetes in police custody has received little attention. Few guidelines are available for police officers to manage people with diabetes who are being detained in custody, despite the risk of metabolic derangement occurring in this situation. The use of drugs and alcohol by the detainee prior to arrest may confuse identification of the symptoms and signs of hyper‐ and hypoglycaemia, and emergency treatment in hospital may be required because of inadequate or inappropriate management while in custody.To evaluate current practice, to identify problem areas and to help implement change, a liaison was established between a specialist diabetes service and the local police force. An experienced diabetes specialist nurse identified problem areas in collaboration with the police custodial team and the forensic nursing service. Input from specialist medical and dietetic staff was sought and issues pertaining to awareness, staff training, equipment and dietary provision were evaluated.This liaison initiative led to the implementation of training for police staff to deal with people with diabetes who require insulin therapy, in blood glucose monitoring and in the management of diabetic emergencies. Equipment for diabetic management in the police station was upgraded, and training provided for its use. Police awareness of the potential problems associated with diabetes was heightened. Audit and further evaluation of these changes are being performed to ensure that these acquired skills and staff competence are maintained. Copyright © 2008 John Wiley & Sons.

Structural and process quality in the management of diabetic emergencies in Germany.

Although acute complications of diabetes account for approximately 3% of all emergency calls, clinically relevant indicators of structural and process quality in the management of diabetic emergencies have not yet been studied. The purpose of this investigation was, therefore, to collect representative data on these indicators for the whole of Germany. Standardized questionnaires comprising 20 items were sent to all 312 emergency medical services in Germany. Apart from demographic data, information was obtained about the diagnostic materials and drugs carried by the ambulances, methods of blood glucose measurement, the level of qualification of the emergency teams, the frequency of diabetic emergencies, and the need for further training. The return rate of the questionnaires was 55%, corresponding to 172 emergency medical service districts serving a total population of 45.3 million. The data revealed deficits with regard to structural and process quality. Thus, only 6% of ambulances carried glucagon and only 11% ketone test strips. In 57% capillary blood was used for glucose determination, in 17% visually read test strips were still used. While in some districts hospital admission after hypoglycaemic episodes was mandatory even for patients well educated about their diabetes, in other districts multimorbid patients on oral antidiabetics were sometimes only treated at the emergency scene. Emergency medical technicians increasingly carried out both the diagnosis and treatment of diabetic emergencies. The structural and process quality of the management of diabetic emergencies in Germany is in need of improvement. The most important factor is continuing education of the entire emergency team.

The Management of Diabetic Emergencies

Loss of glucose homeostasis carries the risk of emergencies at opposite extremes of dysregulation. Hypoglycemic crises arise from high exogenous insulin levels and counterregulatory deficiencies. Conversely, hyperglycemic crises arise from insulin depletion and heightened counterregulation. Emergency treatment aims to identify and reverse the imbalance.