Abstract
Study objective: Hyperglycemia is commonly encountered in the ED; the importance of glucose reduction in patients well enough to be discharged is unknown. Methods: We 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. Results: Among 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. Conclusion: In 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.gov NCT02478190
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1295-1300 |
| Number of pages | 6 |
| Journal | American Journal of Emergency Medicine |
| Volume | 37 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2019 |
Bibliographical note
Funding Information:The authors thank the Hennepin County Medical Center residents and Research Associate Program for their contribution to research in emergency medicine. BD, LK, JC, and MP conceived and designed the investigation. BD and EF supervised the conduct of the study and data collection. BD and LK performed data analysis. JM provided departmental funding for the research infrastructure. BD drafted the article, and all authors contributed substantially to its revision. BD takes responsibility for the paper as a whole.
Publisher Copyright:
© 2018 Elsevier Inc.
