SAT-531 Analyzing the Current Practice Patterns of Clinicians Encountering Hyperglycemia and Type II Diabetes in the Emergency Department

Abstract Disclosure: M. Sheyman: None. P. Peng: None. E. Halm: None. A. Ohri: None. Objectives: Type 2 Diabetes (T2D) is a worsening health crisis, with the Emergency Department (ED) being a frequent point of contact for many patients. However, ED providers’ scope of practice is focused on severe cases of hyperglycemic crisis. We sought to perform an analysis of current practice patterns among ED providers at an academic center, and to propose a clinical decision support intervention to improve the care of T2D patients. Methods: We first performed a retrospective analysis of patients presenting to the ED between 1/1/2024 and 10/1/2024. There were 2,075 patients who had ICD-10 codes grouped to hyperglycemia. 309 patients presented to the ER for symptomatic hyperglycemia. After applying exclusion criteria, 227 patients were included in the analysis. Descriptive statistics were used to evaluate patient demographics and clinical characteristics, including glucose and hemoglobin A1c (A1C) values, treatment modalities, endocrine consultation rate, disposition, medication management and follow-up care. We used these results to develop a prospective clinical trial: Diabetes Electronic Prompt for Improved Care Coordination and Treatment (DEPICCT) in the ED. Results: The mean age of patients was 54.5 years old. 39.6% of the patients were Hispanic. The average body mass index was 30.9 kg/m2. The average initial glucose was 411 mg/dL (164 mg/dL) and average A1c when collected, was 11.0%. Only 32% of patients had an A1c ordered while in the ED. At the end of the ED encounter, the average glucose was 302 mg/dL (113 mg/dL). Regular insulin and fluids were mainly the treatments used. Most of the ED patients (72.1%) were discharged, but only 26% of patients were discharged with diabetes medications and only 29% had a follow-up appointment. Among all patients, 17% had no insurance, 9% were under charity care and 7% with emergency Medicaid. Conclusion: Our results show that majority of the patients presenting to the ER with hyperglycemia are uninsured. These patients often get discharged from ER with oral medications and no follow up care. The management of symptomatic hyperglycemia in the ED is directed primarily to temporizing glucose values. DEPICCT study was formulated as an electronic alert to prompt ER physicians to order HgA1c. DEPICCT alert could result in better physiologic and follow-up care outcomes. This will enable the ED to triage patients who need to be transferred to Observation unit for further treatment and Diabetes Education as opposed to being discharged from the ER. The trial will randomize patients to an intervention group that has practice advisory alert triggers (to order an A1c, to admit a patient to the Observation Unit and to start basal insulin) versus a control arm of usual care. The study results will be presented once the analysis is complete. Our aim is to improve the percentage of patients achieving glycemic control and establish follow up care after an ED visit. Presentation: Saturday, July 12, 2025