Specialized diabetes care may help prevent recurrent emergency department visits

One in three Canadians is living with diabetes or prediabetes. When they experience complications like severe hyperglycemia (high blood sugar), they require emergency care. For many, one emergency department (ED) visit leads to multiple others. 

“There’s an increasing prevalence of diabetes in our population. It’s imperative that we support patients in managing the disease to prevent adverse outcomes and optimize health,” says Dr. Justin Yan, Associate Scientist at Lawson Health Research Institute and Emergency Department Physician at London Health Sciences Centre (LHSC). “In our research, we wanted to see whether specialized diabetes care was associated with a reduction in recurrent ED visits and hospitalizations.”

Dr. Yan and his colleagues studied de-identified data from patients who presented with hyperglycemia to the EDs at LHSC’s Victoria and University Hospitals over a one-year period. They compared those patients who had been followed by specialized diabetes care at St. Joseph’s Health Care London (250 patients) to those who had not (206 patients).

At St. Joseph’s Centre for Diabetes, Endocrinology and Metabolism, patients with diabetes are supported by a dedicated team of endocrinologists, family physician diabetologists, certified diabetes educators (registered nurses and dietitians), nurse practitioners, pharmacists, social workers and social service workers. The multidisciplinary team provides specialized care and comprehensive teaching which includes diet and lifestyle management advice, exercise programs, help with medications and more. 

“Our team provides patient-centered multidisciplinary support to patients with diabetes” says Dr. Selina Liu, Associate Scientist at Lawson, Endocrinologist at St. Joseph’s and co-investigator on the study. “We work with patients to empower them to manage their diabetes with a goal of preventing serious complications, both acute and chronic, including those that can lead to ambulance calls, ED visits and hospitalizations.”

The research team found that patients who had received specialized diabetes care were less likely to revisit the ED due to hyperglycemia (9.6 per cent versus 32.5 per cent) and to be hospitalized due to hyperglycemia (5.2 per cent versus 14.1 per cent) within 30 days of their initial ED visit. 

“While further research is needed, our findings are important for a number of reasons,” notes Dr. Yan. “They suggest that follow-up with specialized diabetes care may prevent recurrent ED visits and hospitalizations. In addition to improving patient outcomes, this could equate to significant cost savings for the health care system.”

The team hopes this knowledge can be used to develop targeted interventions for patients who are at higher risk of returning to hospital for hyperglycemia. They are planning future studies to look at what factors contribute to a patient being at higher risk of adverse outcomes and what interventions are most effective in preventing them. 

The study, “Do adult patients with type 1 or 2 diabetes who present to the emergency department with hyperglycemia have improved outcomes if they have access to specialized diabetes care?,” is published in the Canadian Journal of Diabetes. It was funded by Lawson Health Research Institute’s Internal Research Fund.