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Title: 24-hr observation unit is safe location for rapid glucose control in uncomplicated severe hyperglycaemia
Authors: Ibrahim, I 
Macatangay, R
Chai, CY
Khoo, CM 
Mahadevan, M 
Keywords: Science & Technology
Life Sciences & Biomedicine
Emergency Medicine
Observation unit
Diabetes mellitus
Issue Date: 30-May-2021
Publisher: BMC
Citation: Ibrahim, I, Macatangay, R, Chai, CY, Khoo, CM, Mahadevan, M (2021-05-30). 24-hr observation unit is safe location for rapid glucose control in uncomplicated severe hyperglycaemia. BMC EMERGENCY MEDICINE 21 (1). ScholarBank@NUS Repository.
Abstract: Background: Uncomplicated hyperglycaemia is a common presentation in the emergency department (ED). Rapid glucose control is associated with the risk of iatrogenic hypoglycaemia. We sought to determine the safety of a rapid glucose control protocol delivered in a 24-h emergency department observation unit (OU). Methods: This is a retrospective chart review of patients admitted to the OU for hyperglycaemia where the assessing clinician deemed there was no other reason for medical admission apart from hyperglycaemia; and that the patient could be safely discharged provided their hyperglycaemia was adequately treated. The rapid glucose control protocol consists of 4–6 hourly glucose monitoring and insulin injections according to a sliding scale. We report the demographics, reduction in glucose values and the incidence of hypoglycaemia in the OU. We also determine the rate of discharge from OU and the rate of hospital admission at 30 days. Results: We included 101 patients. The mean age was 53.5 years (95% CI 50.4–56.6) and 64% of patients were male. The mean HbA1c value was 12.8% (95% CI 12.3–13.3). The mean admission and discharge glucose values were 27.2 (95% CI 26.3–28.1) and 13.9 (95% CI 13.2–14.6) mmols/l respectively. There was no incidence of hypoglycaemia in the OU. We successfully discharged 90.1% of the patients from the OU, of which 3 (3.3%) patients were admitted to the hospital within 30 days of discharge. Conclusion: ED OU is a safe location to deliver effective management for patients presented with uncomplicated severe hyperglycaemia.
ISSN: 1471227X
DOI: 10.1186/s12873-021-00460-0
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