Before answering that question, I need to acknowledge EM topics (http://www.emtopics.com/article-a-day/2016/discharge-glucose-level-is-not-associated-with-return-to-ed) for bringing this important article to my attention since this is nearly a daily occurrence in our ED.

So, do you need to lower blood sugar to a magical, non-evidenced based threshold prior to discharge? Like everything, the answer is…. It depends, but in type II diabetics, the answer is probably no. Hooray!! Driver et al. retrospectively reviewed the charts of all adult patients in their ED with a glucose > 400 at any point during their ED stay over a 2 year period. Importantly, they excluded all patients with DM1 and those who were admitted.

Their study population included 566 patient encounters, with a mean FS of 491. Almost all patients received insulin and or fluids and 60% received both insulin and fluids. Discharge glucose levels ranged from 49-694, with 11 people being discharged with FS > 600 (yikes!).

Looking at 7-day outcomes, 9% had a repeat ED visit for hyperglycemia, 4% were hospitalized and 2 (0%) had an admission for DKA.   After adjusting for arrival glucose, whether or not labs were obtained, amount of IV and insulin given, they found NO ASSOCIATION with discharge glucose and repeated ED visit for hyperglycemia or hospitalization for any reason.

This is by no means the nail in the coffin to this debate, but something to think about the next time your attending asks for another liter of IVF and 5 more units of insulin.

 

References:

Driver, BE et al. Discharge Glucose is Not Associated With Short-Term Adverse Outcomes in Emergency Department Patients With Moderate to Severe Hyperglycemia. Ann Emerg Med. 2016 Jun 25. pii: S0196-0644(16)30162-7. doi: 10.1016/j.annemergmed.2016.04.057.

Smith, Clay. Discharge Glucose level is not associated with return to ED. EM Topics. http://www.emtopics.com/article-a-day/2016/discharge-glucose-level-is-not-associated-with-return-to-ed 08/02/16.