Frecuencia y manejo de diabetes mellitus y de hiperglucemia en urgencias: Estudio GLUCE-URG

Álvarez-Rodríguez, Esther; Morales, Inmaculada Laguna; Tuya, Alicia Rosende; Santamaría, Raquel Tapia; Martínez, Alicia Martín; Riquelme, P. López; Palomares, Raúl Merinero; Sánchez, Isabel Portero

doi:10.1016/j.endinu.2016.12.005

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Clinical investigation of inpatient hyperglycaemia is infrequent, 38,39 despite high prevalence 40 and physician support for increased intervention 41 …”

Section: Discussionmentioning

confidence: 99%

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Assessment of glycaemic status in adult hospital patients for the detection of undiagnosed diabetes mellitus: A systematic review

et al. 2022

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Aim In‐hospital blood glucose testing is commonplace, particularly in acute care. In‐hospital screening for hyperglycaemia may present a valuable opportunity for early diabetes diagnosis by identifying at‐risk individuals. This systematic review investigates the extent to which random blood glucose testing in acute and inpatient hospital settings predicts undiagnosed diabetes. Methods Two databases were systematically searched for studies in which adult patients received an in‐hospital random blood glucose test, followed by a diagnostic HbA1c test. The primary outcome was the proportion of hyperglycaemic individuals diagnosed with diabetes by HbA1c. Results A total of 3245 unique citations were identified, and 12 were eligible for inclusion. Ten different blood glucose thresholds, ranging from 5.5 to 11.1 mmol/L, were used to detect hyperglycaemia, indicating that there is no consistent clinical definition for hyperglycaemia. The proportion of participants with hyperglycaemia in each study ranged from 3.3% to 62.1%, with a median (Q1, Q3) of 34.5% (5.95%, 61.1%). The proportion of hyperglycaemic participants found to have a diabetes‐range HbA1c varied from 4.1% to 90%, with a median (Q1, Q3) of 18.9% (11.5%, 61.1%). Meta‐analysis was not possible due to substantial heterogeneity between study protocols. Conclusions All studies consistently identified a proportion of hyperglycaemic hospital patients as having a diabetes‐range HbA1c, showing that in‐hospital blood glucose screening can facilitate diabetes diagnosis. The proportion of hyperglycaemic participants with undiagnosed diabetes varied substantially, indicating a need for further research and consistency in defining in‐hospital hyperglycaemia. This may aid the development of a standardised screening protocol to identify people with possible undiagnosed diabetes.

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“…Clinical investigation of inpatient hyperglycaemia is infrequent, 38,39 despite high prevalence 40 and physician support for increased intervention 41 …”

Section: Discussionmentioning

confidence: 99%

“…Clinical investigation of inpatient hyperglycaemia is infrequent, 38,39 despite high prevalence 40 and physician support for increased intervention. 41 There appears to be a lack of clinical research in this area, with only a small number of studies identified in this review.…”

Section: Summary Of Evidencementioning

confidence: 99%

Assessment of glycaemic status in adult hospital patients for the detection of undiagnosed diabetes mellitus: A systematic review

et al. 2022

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“…In a study by Álvarez-Rodríguez et al 6 in Madrid, Spain, hyperglycemia is a common finding at hospital ECs in patients with diabetes, but little data are available on its frequency, management and subsequent impact based on the assessment made in the EC. The study found the prevalence of patients with diabetes admitted to the hospital from the EC to be very high.…”

Section: The Role Of Ec and Uc In Insulin Initiationmentioning

confidence: 99%

Initiating Insulin in the Emergency Center and Urgent Care to Prevent Hospital Admission for Patients with Hyperglycemia: A Unique Insulin Starter Kit

Davidson

Bergenstal

Conry

et al. 2021

J Diabetes Sci Technol

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Background: Clinicians in the Emergency Center (EC) and Urgent Care (UC) can play a vital role in preventing hospital admissions and improving outcomes of patients with newly diagnosed diabetes or pre-existing diabetes who present with hyperglycemia and the need to initiate insulin. Methods: This article describes a unique EC/UC discharge insulin starter kit protocol with clinician instructions via an Electronic Medical Record (EMR) order set that includes: starting doses for insulin, a prescription for glucose monitoring supplies, and an emergent referral to diabetes education at International Diabetes Center. Patients receive insulin during the EC/UC visit and are provided an insulin pen to take home. Nurses from the EC or UC review and provide educational material on how to use an insulin pen, treating hypoglycemia and healthy eating. The Certified Diabetes Care and Education Specialist (CDCES) sees patients within 24-72 hours after the referral is placed. Results: Within our single healthcare system’s EC and UC (multiple sites), the kit has enabled clinicians to metabolically stabilize patients and decrease the need for hospitalization without experiencing hypoglycemia. In the recent three years of use, of 42 patients given the insulin starter kit, there were only 2 patients with repeat EC/UC visits within the first six months (1 hyperglycemia and 1 hypoglycemia). Conclusions: An insulin starter kit and EMR-based order set initiated in the EC/UC setting is a tool that can be used to improve the quality of care for people with newly diagnosed or pre-existing diabetes experiencing significant hyperglycemia.

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“…En el caso de pacientes que acuden a los servicios de urgencias la prevalencia de DM se eleva hasta el 30% o 40% del total de pacientes atendidos 2 . Si nos centramos en los servicios de emergencias prehospitalarios las cifras se sitúan en 6 millones de pacientes atendidos al año.…”

Section: Introductionunclassified

Management of hypoglycemia in prehospital care by emergency medical responders

Gil Mosquera,

Matías Soler,

Estrada Carmona

et al. 2024

Rev Esp Urg Emerg

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Frecuencia y manejo de diabetes mellitus y de hiperglucemia en urgencias: Estudio GLUCE-URG

Cited by 5 publications

References 22 publications

Assessment of glycaemic status in adult hospital patients for the detection of undiagnosed diabetes mellitus: A systematic review

Assessment of glycaemic status in adult hospital patients for the detection of undiagnosed diabetes mellitus: A systematic review

Initiating Insulin in the Emergency Center and Urgent Care to Prevent Hospital Admission for Patients with Hyperglycemia: A Unique Insulin Starter Kit

Management of hypoglycemia in prehospital care by emergency medical responders

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