Clinical trial NCT06899191: Diabetes Electronic Prompt for Improved Care Coordination and Treatment in the ED
Official title: Diabetes Electronic Prompt for Improved Care Coordination and Treatment (DEPICCT) in the ED
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Type 2 Diabetes
Type 2 Diabetes Mellitus (T2DM)
Hyperglycemia
Insulin Dependent Diabetes
Keywords: Type 2 Diabetes
Electronic Prompt
Emergency Department Diabetes
Practice Advisory
Lead sponsor: Rutgers, The State University of New Jersey
Sponsor class: OTHER
First posted: 2025-03-27
Enrollment: 200
Sex: ALL
Minimum age (years): 21
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: PREVENTION

Brief 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.

Detailed 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.

Eligibility criteria: 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 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 are transferred to another facility

Primary outcomes:
measure: Care Coordination: Follow-Up Care
timeFrame: From date of ED encounter until 4 weeks after
measure: Physiologic Response
timeFrame: From date of ED encounter to 4 months after
Secondary outcomes:
measure: Care Coordination: Disposition
timeFrame: Within 1 day of ED encounter date
measure: Care Coordination: Length of stay
timeFrame: 1 day
measure: Care Coordination: Insurance
timeFrame: Within 3 weeks of ED encounter
measure: Care Coordination: Medication Prescription
timeFrame: 3 days
measure: Care Coordination: Medication Change
timeFrame: 3 days
measure: Care Coordination: Appointment
timeFrame: 3 months
measure: Physiologic: A1c Orders
timeFrame: 1 day
measure: Physiologic: Serum Glucose
timeFrame: 1 day
measure: Physiologic: Hemoglobin A1c percentage
timeFrame: 6 months
measure: Physiologic: Diagnosis
timeFrame: 1 day
measure: Physiologic: ED medications
timeFrame: 1 day
Other outcomes:
Locations:
city: New Brunswick
country: United States
facility: Rutgers, Robert Wood Johnson Hospital
state: New Jersey
Study officials:
References:
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