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Purpose: Determine the reasons diabetic subjects have elevated blood glucose (≥200 mg/dl) coincidental to Emergency Department visits and to suggest strategies for addressing these deficiencies. Method: This is a single site retrospective chart review of diabetic subjects who visited the JAHVA ED, Tampa, Florida. Subjects were selected and charts reviewed using the automatic data mining tool within the Computerized Patient Record System. Inclusion criteria encompassed both males and females with Type 1 or 2 diabetes and a blood glucose ≥200 mg/dl upon arrival. Results: 56 subjects met criteria for inclusion with a mean age of 62 years, A1C of 9.5% and BMI of 31. The duration of diabetes was 11.8 years; 95% (n =52) were males; 73% (n=41) were not adherent with diabetes medications; 57% (n=32) were not adherent with lifestyle changes; 23% (n=13) had not participated in diabetes educational programs. The presence of other comorbidities were not independent reasons to explain the high glucose levels. Conclusions: The reasons why subjects with diabetes reported to the ED with glucose ≥ 200 mg/dl, in order of importance, were limited adherence and lack of participation in diabetes educational programs. Implementing strategies to address these deficiencies should lead to better diabetes control in Veterans.

Causes of Hyperglycemia in Subjects with Diabetes who presented to the JAHVA ED during the Months of July 2009 and January 2010