Safe and Simple Emergency Department Discharge Therapy for Patients with Type 2 Diabetes Mellitus and Severe Hyperglycemia

2009 ◽  
Vol 15 (7) ◽  
pp. 696-704 ◽  
Author(s):  
Ambika Babu ◽  
Avinder Mehta ◽  
Pilar Guerrero ◽  
Zhen Chen ◽  
Peter Meyer ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Emergency Department ◽  
Type 2 Diabetes Mellitus ◽  
Emergency Department Discharge

scholarly journals Management of patients with type 2 diabetes mellitus in the Grand-Aides Program

2019 ◽  
Vol 10 (3) ◽  
pp. 1
Author(s):  
Rebekah M. Compton ◽  
Kimberly S. Bednar ◽  
Peggie E. Donowitz ◽  
M. Norman Oliver
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Emergency Department ◽  
Type 2 Diabetes Mellitus ◽  
Medication Adherence ◽  
Diastolic Blood Pressure ◽  
Home Visit ◽  
Ed Visits

Objective: To evaluate the Grand-Aides Program for patients with type 2 diabetes mellitus (T2DM) according to the variables of body weight, blood pressure, medication adherence, and hospital consultation and readmissions.Methods: Patients ages 18 years or older with a past medical history of T2DM, hypertension (HTN), and/or obesity and who were recently seen in the emergency department (ED) or recently admitted to the hospital were eligible to enroll in the Grand-Aides Program. Eligible patients were identified after hospital or ED discharge and were asked to enroll in the in-home based program from March 2016 through June 2018. In-home visit protocol was defined prior to patient enrollment with intense in-home visits during the first weeks of enrollment followed by monthly visits for the duration of enrollment in the program. In-home visit frequency was adjusted on as needed basis so that patients at higher risk for ED visits or hospitalization were seen more frequently. In-home visits were performed by trained Grand-Aide who for the purpose of this study was a certified nursing assistant (CNA). The Grand-Aide underwent eighty hours of didactic training which included visit protocols, visit schedules, and data collection. The one-on-one in-home patient with every visit were supervised by a registered nurse (RN) or nurse practitioner (NP) via video or telephone contact near the conclusion of the visit. Active patients at the University of Virginia Family Medicine clinic were eligible for enrollment. Fifty-seven patients with T2DM worked with Grand-Aides for three months and an additional forty-eight T2DM patients worked with Grand-Aides for twelve months. Emergency department visits, all 30-day hospital readmissions, as well as blood pressure readings, medication adherence, weights, and glycated hemoglobin (HbA1c) were compared with the prior twelve months.Results: Systolic (p < .001) and diastolic (p < .01) blood pressures decreased (p < .01) at 1 year. At baseline 56 percent of the patients had a systolic blood pressure of >130 mmHg despite treatment; after 12 months, 48 percent of these were < 130. In those whose baseline diastolic blood pressure was > 90 mmHg, 100 percent had diastolic blood pressure < 90 mmHg at 1 year. Medication adherence by ARMS test at 1 year was 94 percent. Despite trending downward, weight and HbA1c did not change significantly. In the preceding, 58 percent had at least one ED visit, which was reduced by 50 percent (p < .01) with Grand-Aides; 30-day all-cause readmissions reduced by 50 percent to 6.3 percent. Conclusions: The Grand-Aides program was associated with a significant change in blood pressure control, high medication adherence and reductions in ED visits and readmissions that compare favorably with published comparative data. For systems “at risk” for preventable increased health care expense burden, the Grand-Aides program can result in significant savings.

scholarly journals Severe Hemolysis With Negative Direct Antiglobulin Test: A Case Report

2021 ◽  
Author(s):  
Mahin Behzadi Fard ◽  
Ali Arianezhad ◽  
Ali Bandehzadeh
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Emergency Department ◽  
Type 2 Diabetes Mellitus ◽  
Total Bilirubin ◽  
Vital Signs ◽  
Direct Antiglobulin Test ◽  
Immune Mediated ◽  
Antiglobulin Test

Abstract A 49-year-old woman with type 2 diabetes mellitus presented to the emergency department. Her examination showed marked pallor, exhaustion, lethargy, yellowish eyes, anorexia, nausea and vomiting. Laboratory analysis revealed: Hemoglobin (Hb) 4.8 g/dl, MCV 91fl, platelet count 233 × 106 /L, Total bilirubin 7.0 mg/dl, Glucose 316 mg/dl, hematuria and normal G6PD. Hemolytic panel was unswerving with hemolysis. IV fluids and 2 units of packed cell were transfused. Despite transfusion, during the first 4 days of hospitalization the hemolysis continued so that immune hemolysis was suspected in spite of negative coomb's test. After 3 weeks of the patient refer to the hospital, she was discharged home with stable vital signs and Hb10 g/dl. Blood transfusion along with corticosteroids, IVIG and rituximab saved the life of this patient. We concluded in cases that presented with a severe drop in hemoglobin, even if there is a negative direct antiglobulin test (DAT) pay special attention to the immune mediated hemolysis and do not be misled with a negative coomb's test.

scholarly journals Characteristics of frequent emergency department users with type 2 diabetes mellitus in Korea

2017 ◽  
Vol 9 (2) ◽  
pp. 430-437 ◽  
Author(s):  
Morena Ustulin ◽  
Junghoon Woo ◽  
Jeong-taek Woo ◽  
Sang Youl Rhee
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Emergency Department ◽  
Type 2 Diabetes Mellitus
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