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Educational intervention to introduce an emergency department hyperglycemia treatment

Alcalde López S, Oliete Blanco MP, Usieto López L, Javierre Loris MA, Parrilla Herranz P, Povar Marco J

Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, Spain.

Objectives: To assess an emergency department (ED) educational intervention leading
to implementation of a hyperglycemia treatment protocol. Our hypothesis was that the
ED educational intervention would increase use of basal-bolus therapy for hospital
management of hyperglycemia.
Methods: Quasi-experimental pre-post intervention study comparing unmatched groups.
Patients treated before and after the intervention were selected consecutively. All were over the age of 18 years and admitted from the ED with a diagnosis of type-2 diabetes and a blood sugar level over 180 mg/dL. The variables analyzed were percentage of patients in
each group treated with basal-bolus therapy, and the degree of glycemic control (days until
blood sugar levels were brought under control, mean blood sugar levels, and number of
hyperglycemic [>180 mg/dL], and hypoglycemic [<60 mg/dL] episodes).
Results: A total of 96 patients (preintervention, 45; postintervention, 51) were included.
The use of basal-bolus therapy increased significantly after implementation of the protocol
(preintervention, 22%; postintervention, 71%; P<.01). We saw no differences in the mean
(SD) number of days until blood sugar levels were brought under control: 4.9 days vs 4.5
days in the pre- and postintervention groups, respectively (P=.43). Likewise, the
percentages of patients achieving glycemic control by day 5 were similar in the 2 groups,
at 51.6% and 56.8%, respectively; P=.65). Hypoglycemia tended to develop less often in
the postintervention group (20% vs 7.5%, respectively) but the difference was not
significant (P=.09).
Conclusion: The educational intervention was effective in leading to the implementation
of basal-bolus therapy for managing hyperglycemia.

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