Synergy to reduce emergency department visits for uncontrolled hyperglycemia.

PURPOSE: The purpose of this pilot study was to evaluate the safety and preliminary efficacy of a treatment algorithm and education intervention for the management of patients with type 2 diabetes and hyperglycemia presenting to the emergency department (ED) and stable enough to be discharged home. METHODS: Urban hospital ED patients (n = 86) with BG ≥ 200 mg/dL were enrolled in a 4-week prospective, nonrandomized pilot intervention with historic self-controls. Follow-up visits occurred at 12 to 72 hours, 2 and 4 weeks, and 6 months. T2DM medications were initiated or adjusted at each visit using a guideline-based diabetes medication management algorithm. Survival skills diabetes self-management education and navigation to outpatient services were provided. RESULTS: Participants were 51.8% male and 92% black, and 87.3% had private or public insurance. The top reasons for presenting to the ED were no provider appointment available (41.7%) and no primary care provider (14.6%). No hypoglycemia occurred in the first 24 hours following ED T2DM medication initiation or titration and overall hypoglycemia rates were low. BG was reduced from 356 ± 110 mg/dL at baseline to 183 ± 103 mg/dL at 4 weeks (P < .001). CONCLUSION: Diabetes medication management and survival skills education for uncontrolled diabetes may be safely initiated in the ED, as demonstrated by the multidisciplinary STEP-DC intervention, which effectively enabled glycemic control in this pilot study.

Emergency management of palpitations in the elderly: epidemiology, diagnostic approaches, and therapeutic options.

Palpitations are a common complaint among elderly patients presenting to the emergency department. Although most are benign, the elderly do have a higher risk of having a cardiac cause. Other causes include psychiatric disorders, and sometimes a combination of cardiac and psychiatric causes coexist. A history and physical examination, including a detailed medication history, are an essential part of the workup in older patients. A 12-lead electrocardiogram is an essential first step toward a diagnosis; other tests are recommended in high-risk patients, including those with underlying coronary artery disease or structural cardiac abnormalities.