Diabetes Electronic Prompt for Improved Care Coordination and Treatment in the ED

NCT06899191 | Completed DMC

• 1 other identifier: Pro2024002629
• Study Type: interventional
• Target: 300
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial is to improve the processes of Type 2 Diabetes (T2D) care coordination and treatment in the emergency department (ED) by utilizing clinical decision support mechanisms in the electronic health record (EHR). The main question is whether electronic prompts triggered by hyperglycemia and elevated A1c results in providers providing earlier treatments and faster time to subsequent primary care appointment and greater reduction in hemoglobin A1c (HA1c). ED clinicians will receive alerts called Our Practice Advisories (OPA's) through the EPIC EHR. The 1st OPA triggers when a random point-of-care (POC) glucose is ≥250 mg/dL, prompting a suggested additional HA1c order. A 2nd OPA triggers if the resulting HA1c is ≥10%, prompting consideration of further care coordination in the Observation Unit. Investigators will compare the outcomes post-intervention compared to pre-intervention.

Conditions

Type 2 Diabetes; Type 2 Diabetes Mellitus (T2DM); Hyperglycemia; Insulin Dependent Diabetes

Keywords

Type 2 Diabetes; Electronic Prompt; Emergency Department Diabetes; Practice Advisory

Outcome Measures

Primary Outcomes (2)

• Care Coordination: Follow-Up Care

  % Patients achieving: A T2D-related appointment within 4 weeks

  From date of ED encounter until 4 weeks after

• Physiologic Response

  % Patients achieving: HbA1c 1% reduction in 3 months

  From date of ED encounter to 4 months after

Secondary Outcomes (11)

• Care Coordination: Disposition

  Within 1 day of ED encounter date

• Care Coordination: Length of stay

  1 day

• Care Coordination: Insurance

  Within 3 weeks of ED encounter

• Care Coordination: Medication Prescription

  3 days

• Care Coordination: Medication Change

  3 days

Study Arms (1)

Intervention

EXPERIMENTAL

All ED providers exposed to electronic alerts

Diagnostic Test: Hemoglobin A1c; Behavioral: Observation Unit

Interventions

Hemoglobin A1c DIAGNOSTIC_TEST

Prompt to order A1c

Intervention

Observation Unit BEHAVIORAL

Electronic prompt nudging ED provider to consider admitting patient to the Observation Unit for care coordination and more aggressive glycemic control

Intervention

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Moderate hyperglycemia, (glucose ≥250 mg/dL)
• Patients who arrive in the emergency department
• Not pregnant or peri-partum
• Not SARS-COV-2 PCR positive in past 7 days

You may not qualify if:

• Diabetic ketoacidosis (pH \< 7.20, HCO3 \< 15, AG \> 25)
• Diabetic foot ulcer or skin complications
• Hyperglycemic hyperosmolar state with neurologic impairment
• Patients who leave against medical advice (AMA), elope from the ED, or are transferred to another facility

Sponsors & Collaborators

• Rutgers, The State University of New Jersey: lead

Study Sites (1)

Rutgers, Robert Wood Johnson Hospital

New Brunswick, New Jersey, 08901, United States

Location

Related Publications (14)

• Yan JW, Vujcic B, Le BN, Van Aarsen K, Chen T, Halane F, Clemens KK. Predictors of 30-day recurrent emergency department visits for hyperglycemia in patients with types 1 and 2 diabetes: a population-based cohort study. CJEM. 2024 Jun;26(6):424-430. doi: 10.1007/s43678-024-00686-4. Epub 2024 Apr 18.

  PMID: 38635005 BACKGROUND

• Magee MF, Nassar C. Hemoglobin A1c testing in an emergency department. J Diabetes Sci Technol. 2011 Nov 1;5(6):1437-43. doi: 10.1177/193229681100500615.

  PMID: 22226261 BACKGROUND

• Magee MF, Nassar CM, Copeland J, Fokar A, Sharretts JM, Dubin JS, Smith MS. Synergy to reduce emergency department visits for uncontrolled hyperglycemia. Diabetes Educ. 2013 May-Jun;39(3):354-64. doi: 10.1177/0145721713484593. Epub 2013 Apr 22.

  PMID: 23610182 BACKGROUND

• King WM 4th, McDermott MT, Trujillo JM. Initial management of severe hyperglycemia in patients with type 2 diabetes: an observational study. Diabetes Ther. 2013 Dec;4(2):375-84. doi: 10.1007/s13300-013-0036-9. Epub 2013 Aug 16.

  PMID: 23949906 BACKGROUND

• Ginde AA, Delaney KE, Pallin DJ, Camargo CA Jr. Multicenter survey of emergency physician management and referral for hyperglycemia. J Emerg Med. 2010 Feb;38(2):264-70. doi: 10.1016/j.jemermed.2007.11.088. Epub 2008 Jul 26.

  PMID: 18657930 BACKGROUND

• Gale J, Varndell W, James S, Perry L. Unscheduled emergency department presentations with diabetes: Identifying high risk characteristics. Australas Emerg Care. 2023 Sep;26(3):205-210. doi: 10.1016/j.auec.2022.12.001. Epub 2022 Dec 15.

  PMID: 36528482 BACKGROUND

• Driver BE, Olives TD, Prekker ME, Miner JR, Klein LR. The Association of Emergency Department Treatments for Hyperglycemia with Glucose Reduction and Emergency Department Length of Stay. J Emerg Med. 2017 Dec;53(6):791-797. doi: 10.1016/j.jemermed.2017.08.068. Epub 2017 Oct 6.

  PMID: 28993036 BACKGROUND

• Driver BE, Olives TD, Bischof JE, Salmen MR, Miner JR. Discharge Glucose Is Not Associated With Short-Term Adverse Outcomes in Emergency Department Patients With Moderate to Severe Hyperglycemia. Ann Emerg Med. 2016 Dec;68(6):697-705.e3. doi: 10.1016/j.annemergmed.2016.04.057. Epub 2016 Jun 25.

  PMID: 27353284 BACKGROUND

• Driver BE, Klein LR, Cole JB, Prekker ME, Fagerstrom ET, Miner JR. Comparison of two glycemic discharge goals in ED patients with hyperglycemia, a randomized trial. Am J Emerg Med. 2019 Jul;37(7):1295-1300. doi: 10.1016/j.ajem.2018.09.053. Epub 2018 Oct 5.

  PMID: 30316635 BACKGROUND

• Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, Rosas SE, Del Prato S, Mathieu C, Mingrone G, Rossing P, Tankova T, Tsapas A, Buse JB. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2022 Dec;65(12):1925-1966. doi: 10.1007/s00125-022-05787-2. Epub 2022 Sep 24.

  PMID: 36151309 BACKGROUND

• Crawford AL, Laiteerapong N. Type 2 Diabetes. Ann Intern Med. 2024 Jun;177(6):ITC81-ITC96. doi: 10.7326/AITC202406180. Epub 2024 Jun 11.

  PMID: 38857502 BACKGROUND

• Charfen MA, Ipp E, Kaji AH, Saleh T, Qazi MF, Lewis RJ. Detection of undiagnosed diabetes and prediabetic states in high-risk emergency department patients. Acad Emerg Med. 2009 May;16(5):394-402. doi: 10.1111/j.1553-2712.2009.00374.x. Epub 2009 Mar 16.

  PMID: 19302369 BACKGROUND

• Bowen ME, Xuan L, Lingvay I, Halm EA. Random blood glucose: a robust risk factor for type 2 diabetes. J Clin Endocrinol Metab. 2015 Apr;100(4):1503-10. doi: 10.1210/jc.2014-4116. Epub 2015 Feb 4.

  PMID: 25650899 BACKGROUND

• American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S20-S42. doi: 10.2337/dc24-S002.

  PMID: 38078589 BACKGROUND

MeSH Terms

Conditions

Diabetes Mellitus, Type 2; Hyperglycemia; Diabetes Mellitus, Type 1

Interventions

Clinical Observation Units

Condition Hierarchy (Ancestors)

Diabetes Mellitus; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Autoimmune Diseases; Immune System Diseases

Intervention Hierarchy (Ancestors)

Hospital Units; Health Facilities; Health Care Facilities Workforce and Services

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: March 21, 2025
• First Posted: March 27, 2025
• Study Start: March 30, 2025
• Primary Completion: April 1, 2026
• Study Completion: April 26, 2026
• Last Updated: April 30, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ANALYTIC CODE
• Time Frame: Until 1 year after study
• Access Criteria: Only the Principal Investigator, PP, will have access

Locations

US (1)