Evaluating the Emergency Department Observation Unit for the management of hyperglycemia in adults

Crilly, Colin; Allen, Amy; Amato, Teresa; Tiberio, Allison; Schulman, Rifka; Silverman, Robert A.

doi:10.1016/j.ajem.2018.02.027

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…The socio‐demographic variables included age, sex, education level, marital status, living conditions, number of chronic diseases, comorbidities, and frequency of falling. In addition, physical indicators were obtained from each subject’s medical records, including haemoglobin A1C, TC, triglyceride (TG), HDL, low‐density lipoprotein (LDL), body mass index (BMI), number of hypoglycaemia frequency (<70 mg/dl) within the past year (Munshi et al, 2011), and the number of hyperglycaemia frequency (>300 mg/dl; Crilly et al, 2018) in the past year.…”

Section: Methodsmentioning

confidence: 99%

Risk factors associated with frailty in older adults with type 2 diabetes: A cross‐sectional study

Lin

Yu²,

et al. 2021

Journal of Clinical Nursing

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Aims and objectives The aims of the study were to (i) estimate the prevalence of frailty among older adults with type 2 diabetes, and (ii) investigate risk factors associated with frailty in the study group. Background The high prevalence of frailty among older adults and its adverse health impacts including higher risks for physical disabilities and a higher mortality rate is quickly evolving to become an important public health issue. Design A cross‐sectional design. Methods Data were collected from the Clinical Diabetes Centre of our study group. Frailty was assessed using the Chinese version of the Tilburg frailty indicator. Other questionnaires included Activities of Daily Living, Mini‐Mental State Examination, Taiwan Geriatric Depression Scale and Instrumental Activities of Daily Living. Multivariable logistic regression was established to identify factors associated with frailty. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used preparing the manuscript. Results A total of 248 subjects were recruited in this study, a total of 66 participants had frailty (26.6%). Our results showed that factors including age, number of chronic diseases, cerebrovascular accident, renal diseases, frequency of falling, frequency of hyperglycaemia, Activities of Daily Living, depression, Mini‐Mental State Examination, and Instrumental Activities of Daily Living ≧1 task disability were correlated with frailty in older adults with type 2 diabetes. After adjusting for confounding factors, multivariate logistic regression analyses showed a significant increase in the probability of frailty by 1.72‐times when comparing type 2 diabetes subjects with depression to those without depression. Conclusion This study revealed that depression is a significant factor associated with the occurrence of frailty among older adults with type 2 diabetes. Relevance to clinical practice Our results provided strong clinical evidence showing depression as an important factor associated with the risk of frailty in older individuals with type 2 diabetes. We recommend early detection via routine screenings for symptoms of depression during diabetes care to achieve early prevention or the delay of frailty and its implicated adverse health consequences.

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Section: Methodsmentioning

confidence: 99%

Risk factors associated with frailty in older adults with type 2 diabetes: A cross‐sectional study

Lin

Yu²,

et al. 2021

Journal of Clinical Nursing

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“…From these 570 papers, 21 relevant records were followed up after duplicate papers, conference abstracts and letters were excluded. [5][6][7]9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Full text was available for 18 papers with abstracts for three entries. The relevant, research papers were from Europe (9, including 4 from the UK), Australia (5), America (5), Canada (1) and East Africa (1).…”

Section: Results Of Literature Searchesmentioning

confidence: 99%

use of HbA1c for new diagnosis of diabetes in those with hyperglycaemia on admission to or attendance at hospital urgently requires research

et al. 2022

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The prevalence of diabetes in Birmingham is 11% but it is 22% in hospital inpatients. Queen Elizabeth Hospital in Birmingham (QEHB) serves a multi-ethnic population with 6% Afro-Caribbean, 19% South Asian and 70% White European. A clinical audit of 18,965 emergency admissions to QEHB showed that 5% were undiagnosed but had admission glucose in the ‘diabetes’ range and 16% were in the ‘at risk’ range. The proportion of Afro-Caribbeans (7%) and South Asians (8%) in the ‘diabetes’ range was higher than White Europeans (5%). Given the magnitude of the problem, this paper explores the issues concerning the use of reﬂex HbA1c testing in the UK for diagnosis of diabetes in hospital admissions. HbA1c testing is suitable for most patients but conditions affecting red blood cell turnover invalidate the results in a small number of people. However, there are pertinent questions relating to the introduction of such testing in the NHS on a routine basis. Literature searches on a topical question ‘Is hyperglycaemia identiﬁed during emergency admission/attendance acted upon?’, were performed from 2016 to 2021 and 2016 to 2022. They identiﬁed 21 different, relevant, research papers - 5 from Australia, 9 from Europe including 4 from the UK, 5 from America and 1 each from Canada and Africa. These papers revealed an absence of established procedures for the management and follow-up of routinely detected hyperglycaemia using HbA1c when no previous diabetes diagnosis was recorded. Further work is required to determine the role of reﬂex HbA1c testing for diagnosis of diabetes in admissions with hyperglycaemia, and the cost-effectiveness and role of point-of-care HbA1c testing.

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“…A study by Crilly et al described a similar 24-h OU experience in managing patients with hyperglycaemia with regards to average age, chronicity of poorly controlled diabetes as reflected by the admission HbA1c and blood glucose achieved at discharge [ 12 ]. However, our study had a higher proportion of patients with initial blood glucose value above the 22.2 mmol/L (400 mg/dl).…”

Section: Discussionmentioning

confidence: 99%

“…Weighing the need for optimal blood glucose control and minimizing the risk of iatrogenic hypoglycaemia, an observation unit (OU) would appear to be a reasonable location to deliver rapid care and ensure patient safety. Previous studies had either described the care of diabetic patients with hyperglycaemia in an OU for more than 2 days; or had not reported the incidence of iatrogenic hypoglycaemia [ 9 – 12 ]. The advantages of using OU as a location include a greater time margin to discharge the patient and having a dedicated team to care for the patients; as opposed to the ED, which frequently attends to concurrent emergencies.…”

Section: Introductionmentioning

confidence: 99%

24-hr observation unit is safe location for rapid glucose control in uncomplicated severe hyperglycaemia

et al. 2021

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Background 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). Methods This 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. Results We 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. Conclusion ED OU is a safe location to deliver effective management for patients presented with uncomplicated severe hyperglycaemia.

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Evaluating the Emergency Department Observation Unit for the management of hyperglycemia in adults

Cited by 9 publications

References 30 publications

Risk factors associated with frailty in older adults with type 2 diabetes: A cross‐sectional study

Risk factors associated with frailty in older adults with type 2 diabetes: A cross‐sectional study

use of HbA1c for new diagnosis of diabetes in those with hyperglycaemia on admission to or attendance at hospital urgently requires research

24-hr observation unit is safe location for rapid glucose control in uncomplicated severe hyperglycaemia

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