Diabetes Electronic Prompt for Improved Care Coordination and Treatment in the ED

Last updated: May 3, 2025
Sponsor: Rutgers, The State University of New Jersey
Overall Status: Active - Recruiting

Phase

N/A

Condition

Diabetes Mellitus, Type 1

Diabetes Mellitus, Type 2

Diabetes And Hypertension

Treatment

Hemoglobin A1c

Observation Unit

Clinical Study ID

NCT06899191
Pro2024002629
  • Ages > 21
  • All Genders

Study Summary

The goal of this clinical trial is to improve the processes of Type 2 Diabetes (T2D) care coordination and treatment in the emergency department (ED) by utilizing clinical decision support mechanisms in the electronic health record (EHR). The main question is whether electronic prompts triggered by hyperglycemia and elevated A1c results in providers providing earlier treatments and faster time to subsequent primary care appointment and greater reduction in hemoglobin A1c (HA1c).

ED clinicians will receive alerts called Our Practice Advisories (OPA's) through the EPIC EHR. The 1st OPA triggers when a random point-of-care (POC) glucose is ≥250 mg/dL, prompting a suggested additional HA1c order. A 2nd OPA triggers if the resulting HA1c is ≥10%, prompting consideration of further care coordination in the Observation Unit. Investigators will compare the outcomes post-intervention compared to pre-intervention.

Eligibility Criteria

Inclusion

Inclusion Criteria:

Moderate hyperglycemia, (glucose ≥250 mg/dL)

  • Patients who arrive in the emergency department

  • Not pregnant or peri-partum

  • Not SARS-COV-2 PCR positive in past 7 days

Exclusion

Exclusion Criteria:

  • Diabetic ketoacidosis (pH < 7.20, HCO3 < 15, AG > 25)

  • Diabetic foot ulcer or skin complications

  • Hyperglycemic hyperosmolar state with neurologic impairment

  • Patients who leave against medical advice (AMA), elope from the ED, or aretransferred to another facility

Study Design

Total Participants: 200
Treatment Group(s): 2
Primary Treatment: Hemoglobin A1c
Phase:
Study Start date:
March 30, 2025
Estimated Completion Date:
March 31, 2026

Study Description

Type 2 Diabetes (T2D) is a growing public health crisis with rates of diabetes steadily increasing over the last 10 years. The ED is commonly the first point of contact for individuals who present with symptoms of hyperglycemia, often with very severe (HbA1C > 10%) underlying diabetes. However, there is currently no national guideline or clinical policy for the ED management of patients who are not in diabetic ketoacidosis (DKA) or in a hyperglycemia hyperosmolar state (HHS). The investigators hypothesize that there are two subgroups who may benefit from greater care coordination initiated from the ED: patients who are newly-diagnosed with severe T2D and patients whom T2D is poorly-controlled despite medication adherence. This study designs electronic prompt practice advisories that nudge ED providers towards more aggressive treatment pathways. It is currently unknown whether alert tools can improve the delivery and coordination of care of patients with severe T2D presenting to the ED.

Connect with a study center

  • Rutgers, Robert Wood Johnson Hospital

    New Brunswick, New Jersey 08901
    United States

    Active - Recruiting

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.