Magee, Michelle Fischmann
Synergy to control emergency department hyperglycemia in type 2 diabetes project: STEP-diabetes
General Research Subject: Type 2 Diabetes
Focus: Diabetes Education, Health Care Delivery/Economics
Type of Grant: Clinical Translational Research
Project Start Date: July 1, 2011
Project End Date: June 30, 2013
Type 2 diabetes is a medical condition affecting millions of Americans. Because diabetes is a chronic condition which can be difficult to manage, many patients with diabetes find themselves in medically critical situations that lead to frequent trips to the Emergency Department (ED). In the US, treatment of chronic conditions in the ED causes a burden on hospitals both financially and logistically. Therefore, helping patients with chronic conditions to learn better self-management skills is an important part of reducing overall ED visits in this country. The researchers are proposing to enroll 100 patients coming to the ED of a large urban hospital with high blood sugars in a study that will test the effectiveness of a new program. The patients who enroll in the study will be randomized (assigned by chance) to one of two groups; group one will receive a newly configured combination of treatments (treatment group) while group two will receive standard ED care. The treatment group will receive medication management based on specific guidelines, education in diabetes management, and help in navigating the healthcare system. The researchers assume that as the study progresses, those in the treatment group will present with improved blood sugars and will have fewer return visits to the emergency department. If the approach studied in this project is found to be successful in lowering patients' blood sugars and decreasing the number of ED visits, it could potentially help many patients with type 2 diabetes currently struggling to manage their condition.
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?
The Emergency Departments (ED) of hospitals are frequently used as a 'safety net' for the acute management of chronic medical conditions - including type 2 diabetes mellitus. This results in ED crowding and poses a burden on the US healthcare system. I believe that ED visits provide an opportunity to both identify previously undiagnosed diabetes - and - to take action to improve the management of poorly controlled type 2 diabetes, so that diabetes patients may have better health and lowered risk for acute and chronic diabetes complications. Research is needed to establish the best ways to safely and effectively manage uncontrolled type 2 diabetes presenting to the ED.
This program seeks to support and improve diabetes care delivery and health outcomes in vulnerable, eg elderly, low income, and/or minority, persons with uncontrolled blood sugar ?200mg/dL who seek care in the ED of a large city hospital. Our study will test a program that combines: medications for type 2 diabetes treatment; 'survival skills' self-management education; and health system navigation to follow-up care services. We will be examining improvements in blood sugar control and the frequency of return visits to the emergency room which result from the study intervention.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?
The STEP-Diabetes project is working to help define one of the pieces of the as yet incomplete jigsaw puzzle that is comprehensive care for all persons with diabetes. It is attempting to assure that if you ever visit a hospital emergency room because your blood sugars are out of control that the health care team there has strong evidence to guide them in providing best possible care, both in terms of prescribing your diabetes medicines and in terms of teaching you how to use them safely and well.
Why is it important for you, personally, to become involved in diabetes research? What role will this award play in your research efforts?
As a diabetes specialist I know that research plays a key role at many
levels in bringing change that improves the lives of persons living with
diabetes. We would not have the many medications and devices that are
available to treat diabetes today without research. Being involved in
research gives me the opportunity to help develop solutions that may
make a difference not only to my own patients but also to many others
with diabetes. I am most interested in research that takes knowledge of
how to treat diabetes from 'bench-to-bedside' and then out into the
everyday world to help patients meet the challenge of taking charge of
their diabetes, so that they control it, and it will not control them.
For me one key issue that has not received enough attention in this
regard is assuring that the patient has received, understands and can
apply diabetes self-management education. This will allow him/her to
make informed decisions regarding diabetes care on a daily basis,
offering the possibility of better overall control.
This ADA Award will allow me to further test a promising program which has been developed at my hospital to determine if our preliminary results showing improvement in blood sugar control and a trend for reduction in return visits to the emergency department for uncontrolled high blood glucose can be confirmed in a formal randomized (like the flip of a coin), controlled (in which half of the patients receive the STEP-Diabetes program and half do not). Such a study would enable us to put the program forward as a possible best practice for management of type 2 diabetes in the ED for use in other hospitals to benefit their patients.
In what direction do you see the future of diabetes research going?
Diabetes research is moving forward at high speed on multiple fronts all
around the world in both the control and prevention arenas. We are on
the threshold of, and indeed in the midst of, breakthroughs in many
- Technology is improving in leaps and bounds. It already impacts the ability of patients to track and manage their blood sugars in exciting ways, including through the use of continuous glucose sensors and the artificial pancreas. Self-care management technology platforms are beginning to emerge and research must play a strong role in defining and refining their full potential moving forward.
- Ongoing pharmacogenomics research offers the hope of individualized medications and regimens that will more effectively control diabetes.
- While it has been slow in coming there is finally an increased recognition that in the face of the rising tide of diabetes prevention must be addressed. While research has played a key role in providing evidence that diabetes can be prevented -further evidence is now needed to determine how best to implement prevention practices nation-wide, and indeed world-wide.
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