Endocr Pract. 2021 Jul 5:S1530-891X(21)01118-6. doi: 10.1016/j.eprac.2021.06.018. Online ahead of print.
OBJECTIVE: Severely uncontrolled Diabetes Mellitus (DM) is associated with poor long-term outcomes, and may remain unrecognized. A high frequency of uncontrolled DM has been identified in the acute care setting, including the Emergency Department Observation Unit (EDOU). We assess the use of standardized endocrine consultation in the EDOU for Hemoglobin A1c (HbA1c) ≥ 9%.
MATERIALS AND METHODS: Standard practice in our EDOU includes universal HbA1c screening and endocrine consultation for HbA1c ≥ 9.0%. As part of a quality improvement program, EDOU patients with HbA1c ≥ 9.0% had an endocrinology consult. One month follow up phone calls assessed effects of consultation after discharge.
RESULTS: 3,688 (95.7%) of 3,853 EDOU patients received an HbA1c test. 7.0% (n=258) were found to have HbA1c ≥ 9% (Mean HbA1c 11.7 ±1.8%; range 9 - 16.6%). Endocrine consults were completed for 190/258 (73.6%) patients with severely uncontrolled DM. Among the 190 patients, 92.1% (n=175) had discharge DM medication adjustments. Known DM patients (n=142) injectable diabetes medication prescriptions increased from 47.2% (67/142) on EDOU arrival to 78.2% (111/142) on discharge. Newly diagnosed DM injectable prescriptions increased from 0% (0/48) on arrival to 72.9% (35/48) on discharge. A total of 72.6% (n=138) were contacted at one-month and 94.9% (n=131) reported taking DM medications compared to 68.2% (n=94) prior to consult.
CONCLUSIONS: HbA1c screening coupled with endocrine consultation for HbA1c ≥ 9.0% was assessed as a performance improvement study and shown to have valuable results. Further study is recommended to determine long-term clinical impact and cost analysis of this novel approach.