- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02269098
The Synergy to Control Emergency Department Hyperglycemia Program for Type 2 Diabetes (STEP-DM)
The Synergy to Control Emergency Department Hyperglycemia Program for Type 2 Diabetes: STEP-Diabetes.
Study Overview
Status
Intervention / Treatment
Detailed Description
We evaluated a concise diabetes care delivery intervention designed to advance glycemic medications and deliver diabetes self-management education (DSME) among adults with type 2 diabetes presenting to the emergency department (ED) with uncontrolled hyperglycemia. The primary hypothesis was that there would be improvement in HbA1c.
A 4 week, randomized controlled trial provided algorithm-based antihyperglycemic medications management, survival skills DSME and navigation to primary care for ED patients with BG > 200mg/dL. Medications were titrated and DSME delivered by endocrinologist-supervised certified diabetes educators. Controls received usual care.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
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District of Columbia
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Washington, District of Columbia, United States, 20010
- MedStar Washington Hospital Center
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- A new or existing diagnosis of type 2 diabetes;
- BG > 200 mg/dl in the ED;
- age >/= 18 years;
- willing and able to check BG and self-inject insulin, if required and otherwise stable for discharge to the outpatient setting.
Exclusion Criteria:
- type 1 diabetes and other specific types of diabetes per the American Diabetes Association Position Statement on the Classification of Diabetes Mellitus,
- pregnancy or anticipated conception in the next 3 months;
- treatment with a glucocorticoid, unless at a stable physiologic replacement dose; or
- a history of diabetic ketoacidosis.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention
Diabetes survival skills self-management education; plus diabetes medication management using medication algorithm by diabetes educator supervised by endocrinologist, plus health system naviagation. Metformin, sulfonylureas and basal insulin were included in the algorithm. Survival skills DSME included: BG meter instruction if the patient did not already have a meter or confirmation of self-BG monitoring technique if they did; instructions on how to self-inject insulin if prescribed; and information on BG targets, signs and treatment of hypoglycemia and hyperglycemia, basic nutrition information and when to call the doctor or go to the ED. |
As above plus- Follow-up intervention visits were at 24-72 hrs, 2 and 4 weeks.
During each, further DSME was provided, BG logs reviewed, and diabetes medications adjusted as needed by the CDE.
Meter and insulin injections skills were reinforced as needed.
Outpatient navigation included securing a primary care appointment no later than 4 weeks after study completion.
Final contact was via telephone at 90 days.
The MMS© (Morisky Medication Adherence Survey) was taken at 2 and 4 weeks and during the final telephone visit.
Interim return visits to the ED or admissions to the hospital were queried at each visit.
A follow up HbA1C was obtained at week 4 using the POC A1CNow+ ®, and a venous HbA1C was drawn if the POC result was above 13% .
Other Names:
|
No Intervention: Control
Usual ED care was provided to controls.
Hyperglycemia was treated with rapid acting insulin and with IV hydration, if indicated.
DM medications were added and/or doses were adjusted at the discretion of the ED physician and prescriptions provided.
Insulin, however, was not prescribed as a new medication due to staff concerns regarding post-discharge hypoglycemia and lack of certainty of timely medical follow-up.
Follow-up with primary care was recommended.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemoglobin A1C at 4 Weeks
Time Frame: 4 weeks
|
Hemoglobin A1C at index/baseline visit in the ED and at 4 weeks.
A1C was measured using the Bayer A1C-Now+ point of care test system device.
If the reading was over 13%, the upper limit of the assay, a venous sample A1C was sent to the hospital lab for analysis.
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4 weeks
|
Medication Adherence
Time Frame: 4 weeks
|
Score on 8 item Modified Morisky Medication Scale used to assess medication adherence.
This scale is a structured and widely used self reported questionnaire used to assess medication taking behaviors.The total score ranges from 0 to 8. A score of 0 is considered "high"adherence, 1 to 2 is considered "medium" adherence, and >2 is considered "low" adherence.
|
4 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Blood Glucose < 180mg/dL
Time Frame: 4 weeks
|
Number of patients in each group with BG < 180 mg/dl at 4 weeks from baseline
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4 weeks
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Hypoglycemia
Time Frame: 4 weeks
|
Hypoglycemia was defined as BG < 70mg/dL.
Severe hypoglycemia was defined as BG <40mg/dL and/or requiring assistance to treat.
We tracked the total number of hypoglycemia episodes in each group.
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4 weeks
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ED Visits and Hospitalizations
Time Frame: 12 weeks
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number ED visits and hospitalizations pre and post intervention as self-reported by participants
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12 weeks
|
Collaborators and Investigators
Investigators
- Principal Investigator: Michelle F Magee, MD, MBBCh, MedStar Health Research Institute
Publications and helpful links
General Publications
- Magee MF, Nassar C. Hemoglobin A1c testing in an emergency department. J Diabetes Sci Technol. 2011 Nov 1;5(6):1437-43. doi: 10.1177/193229681100500615.
- Magee MF, Nassar CM, Copeland J, Fokar A, Sharretts JM, Dubin JS, Smith MS. Synergy to reduce emergency department visits for uncontrolled hyperglycemia. Diabetes Educ. 2013 May-Jun;39(3):354-64. doi: 10.1177/0145721713484593. Epub 2013 Apr 22.
- Lewis VR, Benda N, Nassar C, Magee M. Successful patient diabetes education in the emergency department. Diabetes Educ. 2015 Jun;41(3):343-50. doi: 10.1177/0145721715577484. Epub 2015 Mar 24.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2011-010
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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