Diabetes mellitus (DM) is an increasingly prevalent chronic disease, with estimates that up to 40% of adults may develop DM over their lifetime. Patients with poorly controlled DM often visit the ED for management of hyperglycemic episodes, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS).
A previous study by our group attempted to identify risk factors that predicted unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation. Factors independently associated with a recurrent visit included a previous hyperglycemia visit in the past month, age <25 years, glucose >20mmol/L, having a family physician, and being on insulin. However, this study had its limitations due to its retrospective nature and inability to capture certain patient characteristics that may have influenced the risk of a subsequent ED visit. A follow-up prospective study is needed in order to confirm the previously reported factors and prospectively assess for additional variables that may influence this outcome.
This will be a multicentre prospective cohort study of eligible consecutive adult patients with an ED diagnosis of hyperglycemia, DKA or HHS. Potential cases of patients with diabetes on treatment will be identified from the local site ED patient tracking system. Trained research assistants will screen the charts of these cases, and all potentially eligible patients will be followed for recurrent ED visits. Emergency physicians will confirm eligibility for enrolment and obtain informed consent for the research team to contact the patient for telephone follow-up.
Research assistants will then contact the participants enrolled in the study between 10-14 days via telephone for follow-up with respect to obtaining data regarding clinical outcomes. Research assistants will also follow these patients electronically to determine if they have any further ED visits, admissions or ICU admissions after their ED visit for hyperglycemia.
Impact on EM
We hypothesize that we will be able to identify potentially modifiable risk factors that may predict recurrent visits for hyperglycemia, such as specific patient demographics, comorbidities and lack of access to follow-up. The results of this project will assist clinicians to better identify these patients and enable them to intervene either medically or educationally to prevent subsequent visits to the ED. As a result, patients will have improved care, better blood sugar control, and be identified for closer follow-up with a family physician or diabetes specialist.