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Washington, DC, United States

Magee M.,MedStar Diabetes Institute | Magee M.,MedStar Research Institute | Bowling A.,MedStar Research Institute | Fokar A.,MedStar Research Institute | And 2 more authors.
Diabetes Educator | Year: 2011

Purpose The purpose of the study was to examine the feasibility and impact of a concise community-based program on diabetes self-management education (DSME), according to frequency of emergency department visits and knowledge of, prescriptions for, and control of A1C, blood pressure, and low-density lipoprotein (LDL) cholesterol. Methods A free community-based DSME program was placed in a public library. Adults with diabetes (N, 360) consented to participate in this prospective nonrandomized cohort study with preintervention-postintervention design. The small-group interactive DSME (two 2.5-hour classes) focused on improving cardiovascular disease risk factors and facilitating communication with the primary care physician. Results An increase in knowledge of American Diabetes Association-recommended targets for A1C, blood pressure, and LDL cholesterol from baseline to postintervention was seen among participants. Significant clinical outcomes included reduction in self-reported emergency department visits and reduction in mean A1C. However, despite an increase in prescriptions written for lipid-lowering drugs, blood pressure and LDL cholesterol did not change. Participants who started on insulin were more likely to achieve or maintain A1C < 7% compared to those who either did not take or stopped taking insulin during the study. Conclusions Offering DSME classes for African Americans at a public library was feasible and significantly affected 6-month clinical outcomes, including a reduction in A1C, an increased likelihood of attaining a target A1C of < 7% if insulin was started during the study period, and a two-thirds reduction in emergency department visits for uncontrolled diabetes. Observed results suggest that partnering with community-based organizations such as public libraries offers an accessible and well-received location for offering DSME programs. © 2011 The Author(s).

Magee M.F.,MedStar Research Institute | Magee M.F.,MedStar Diabetes Institute | Magee M.F.,Georgetown University | Nassar C.,MedStar Research Institute | Nassar C.,MedStar Diabetes Institute
Journal of Diabetes Science and Technology | Year: 2011

Background: Emergency department (ED) visits for hyperglycemia are common and costly. Enhanced strategies for recognizing and managing patients with diabetes in the ED are needed. Hemoglobin A1c (A1C) testing is typically used to assess level of glycemic control in the 2-3 months preceding an ofice visit. In this article, we report on potential roles for point-of-care (POC) A1C testing in the ED for patients presenting with uncontrolled hyperglycemia. Methods: We enrolled patients presenting to an urban tertiary care hospital ED with blood glucose (BG) ≥200 mg/dl who were otherwise stable for discharge (n = 86) in a prospective, nonrandomized pilot study. Antihyperglycemic medication management, survival-skills diabetes self-management education, and health system navigation were provided. Followup visits took place at 24-72 hours and at 2 and 4 weeks. Point-of-care A1C testing was performed at baseline and at 2 weeks. Baseline A1C results were used by the ED physician and the educator to inform the patient of likely preadmission glycemic classification, and the potential role that the (diabetes mellitus) DM medication regimen assigned in the ED had in enabling overall progress in glycemic control at 2 weeks post-ED initiation of treatment. Results: At baseline, 50% of POC A1C values were >13%. Mean BG fell from 356 ± 110 mg/dl to 183 ± 103 mg/dl at 4 weeks (average decrease of 173.5 g/dl, p < 0.001). Mean A1C fell by 0.4%, from 12.0 ± 1.5% to 11.6 ± 1.6% at 2 weeks, p = 0.048. There were zero instances of day 1 hypoglycemia and overall hypoglycemia rates were low (1.3%). Conclusions: Point-of-care A1C testing in the ED helped inform both the provider and the patient of likely prior glycemic status, including unrecognized or uncontrolled type 2 diabetes, and allowed emphasis of the importance of timely diabetes self-management education and medication management in preventing acute and chronic complications. Followup POC A1C testing at 2 weeks was used to confirm early improvement in glycemic control postintervention. © Diabetes Technology Society.

Shomali M.E.,Union Memorial Hospital | Herr D.L.,Washington Hospital Center | Hill P.C.,Washington Hospital Center | Pehlivanova M.,MedStar Research Institute | And 5 more authors.
Diabetes Technology and Therapeutics | Year: 2011

Background: No study of transition from intravenous to subcutaneous insulin after cardiac surgery with dose based on percentage of intravenous total daily insulin (TDI) has reported a clearly superior regimen for achieving target blood glucose. We compared three first-dose transition strategies for insulin glargine: two based on TDI alone and one that also took body weight into account. Methods: Mostly obese, type 1 and type 2 diabetes patients (n = 223) undergoing cardiac surgery were randomized to receive insulin glargine subcutaneously at 60% or 80% of TDI or in a dose based on TDI and body weight. Results: Transition to subcutaneous insulin occurred 27.4 ± 6.6?h after surgery. Over the study period, mean proportion of blood glucose values within target range (80-140?mg/dL) were 0.34 ± 0.24, 0.35 ± 0.24, and 0.36 ± 0.22 in the 60% TDI, 80% TDI, and weight-based groups, respectively. This difference was not significant. Significantly more insulin corrections were needed in the 60% TDI group than in the weight-based group. There was only one incidence of hypoglycemia (blood glucose <40?mg/dL). Conclusions: No subcutaneous insulin regimen implemented approximately 1 day after cardiac surgery showed significantly better control of blood glucose over the 3-day study period. Further studies are needed to determine optimal formulae for effecting an early transition to subcutaneous insulin after cardiac surgery or whether it is preferable and/or necessary to continue intravenous insulin therapy for an additional period of time. © Mary Ann Liebert, Inc.

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