Impact of a Subcutaneous Insulin Protocol in the Emergency Department: Rush Emergency Department Hyperglycemia Intervention (REDHI)

Objective: We evaluated a hyperglycemia treatment protocol for use in the Emergency Department (ED) in patients with diabetes mellitus (DM) before admission to the hospital or discharge home. Methods: Fifty-four consecutive patients with a history of DM and an ED admission blood glucose (BG) > 200 mg/dL were treated with subcutaneous (SQ) insulin aspart every 2 h until BG was < 200 mg/dL. Point-of-care BG was measured immediately on ED admission and every 2 h until discharge home or hospital admission. The intervention group was compared with 54 historical controls with DM and an ED admission BG > 200 mg/dL. Results: One hundred percent of intervention patients received insulin aspart, whereas only 35% of historical controls received insulin therapy. In the intervention group, mean BG declined from 333 ± 104 mg/dL on ED admission to 158 ± 68 mg/dL on ED discharge. In the historical control group, mean BG decline was significantly less, from 322 ± 126 mg/dL on admission to 242 ± 79 mg/dL on discharge (p < 0.001). Sixty-nine percent of intervention patients and 67% of controls were subsequently admitted to the hospital. Mean hospital length of stay (LOS) in the intervention group was significantly less, 3.8 ± 3.3 days, compared with 5.3 ± 4.1 days in the control group (p < 0.05). Four intervention patients (7.4%) developed a BG < 70 mg/dL. Conclusion: A protocol for the treatment of acute hyperglycemia in the ED can be safely implemented. Subsequent inpatient LOS was reduced. Further randomized clinical trials of this intervention are warranted.