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

Type 2 Diabetes (T2D) is a growing public health crisis with rates of diabetes steadily increasing over the last 10 years. The ED is commonly the first point of contact for individuals who present with symptoms of hyperglycemia, often with very severe (HbA1C > 10%) underlying diabetes. However, there is currently no national guideline or clinical policy for the ED management of patients who are not in diabetic ketoacidosis (DKA) or in a hyperglycemia hyperosmolar state (HHS). The investigators hypothesize that there are two subgroups who may benefit from greater care coordination initiated from the ED: patients who are newly-diagnosed with severe T2D and patients whom T2D is poorly-controlled despite medication adherence. This study designs electronic prompt practice advisories that nudge ED providers towards more aggressive treatment pathways. It is currently unknown whether alert tools can improve the delivery and coordination of care of patients with severe T2D presenting to the ED.

Inclusion criteria

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

Exclusion criteria

• 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