Comparison of two glycemic discharge goals in ED patients with hyperglycemia, a randomized trial.

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.govNCT02478190.

• Authors: Brian E Driver, Lauren R Klein, Jon B Cole, Matthew E Prekker, Erik T Fagerstrom, James R Miner
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 37 Issue 7 Pg. 1295-1300 (07 2019) ISSN: 1532-8171 [Electronic] United States
• PMID: 30316635 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Blood Glucose

Topics

• Blood Glucose (analysis)
• Emergency Service, Hospital
• Female
• Humans
• Hyperglycemia (blood)
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Patient Discharge
• Prospective Studies