Safe and simple emergency department discharge therapy for patients with type 2 diabetes mellitus and severe hyperglycemia
Abstract
Objective To investigate the safety and effectiveness of 2 simple discharge regimens for use in patients with type 2 diabetes mellitus (DM2) and severe hyperglycemia, who present to the emergency department (ED) and do not need to be admitted. Methods We conducted an 8-week, open-label, randomized controlled trial in 77 adult patients with DM2 and blood glucose levels of 300 to 700 mg/dL seen in a public hospital ED. Patients were randomly assigned to receive glipizide XL, 10 mg orally daily (G group), versus glipizide XL, 10 mg orally daily, plus insulin glargine, 10 U daily (G+G group). The primary outcome was to maintain safe fasting glucose and random glucose levels of Results Baseline characteristics were similar between the 2 treatment groups. The primary outcome was achieved in 87% of patients in both treatment groups. The enrollment mean blood glucose values of 440 and 467 mg/dL in the G and G+G groups, respectively, declined by the end of week 1 to 298 and 289 mg/dL and by week 8 to 140 and 135 mg/dL, respectively. Homeostasis model assessment of beta-cell function and early insulin response improved 7-fold and 4-fold, respectively, in responders at the end of the 8-week study. Conclusion Sulfonylurea with and without use of a small dose of insulin glargine rapidly improved blood glucose levels and beta-cell function in patients with DM2. Use of sulfonylurea alone once daily can be considered a safe discharge regimen for such patients and an effective bridge between…
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There is evidence that people with type 2 diabetes and severe hyperglycemia can also be effectively treated with a sulfonylurea, a GLP-1 RA, or dual GIP and GLP-1 RA, though evidence is scarce for individuals with baseline A1C above 10-12%.
“Additionally, there is evidence that people with type 2 diabetes and severe hyperglycemia can also be effectively treated with a sulfonylurea, a GLP-1 RA, or dual GIP and GLP-1 RA, though evidence is scarce for individuals with baseline A1C above 10-12% (104,109-111).”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [109]
Cites
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9. Pharmacologic Approaches to Glycemic Treatment: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s009 · Cited by 1,555 · see citing works
“However, there is evidence that patients with uncontrolled hyperglycemia associated with type 2 diabetes can also be effectively treated with a sulfonylurea (51).”
Background9. Pharmacologic Approaches to Glycemic Treatment: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s009 · Cited by 972 · see citing works
“However, there is evidence that patients with uncontrolled hyperglycemia associated with type 2 diabetes can also be effectively treated with a sulfonylurea (43).”
Background9. Pharmacologic Approaches to Glycemic Treatment: <i>Standards of Medical Care in Diabetes—2020</i>
American Diabetes Association (2020) · Diabetes Care · doi:10.2337/dc20-s009 · Cited by 914 · see citing works
“controlled hyperglycemia associated with type 2 diabetes can also be effectively treated with a sulfonylurea (41).”
Background9. Pharmacologic Approaches to Glycemic Treatment: <i>Standards of Care in Diabetes—2023</i>
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s009 · Cited by 851 · see citing works
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9. Pharmacologic Approaches to Glycemic Treatment: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Gaglia, J. L., Hilliard, M. E., Johnson, E. L., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s009 · Cited by 662 · see citing works
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026
Bajaj, M. S., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Early, K. B., ChallaSivaKanaka, S., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc26-s009 · Cited by 302 · see citing works
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Insulin Therapy: A Personal Approach
Davidson, M. B. (2015) · Clinical Diabetes · doi:10.2337/diaclin.33.3.123 · Cited by 29 · see citing works
“Almost all patients with newly diagnosed type 2 diabetes will respond quickly to maximal doses of a sulfonylurea with reduction of the initial dose often necessary to avoid hypoglycemia (15,16).”
BackgroundChoi, S., Lee, Y.-J., Hwang, G., Chung, J. H., Lee, S., Lee, J.-H., Han, S. J., Kim, H. J., Lee, K. W., Kim, Y., et al. (2010) · Archives of Biochemistry and Biophysics · doi:10.1016/j.abb.2010.10.011 · Cited by 21 · see citing works
Magee, M. F., Nassar, C. M., Mete, M. Y., White, K., Youssef, G. A., & Dubin, J. S. (2015) · Endocrine Practice · doi:10.4158/ep15655.or · Cited by 23 · see citing works
Amblee, A., Lious, D., & Fogelfeld, L. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-4097 · Cited by 16 · see citing works
“In the only prospective randomized trial, glipizide proved to be as effective as insulin in lowering quickly high BG levels (range of 300–700 mg/dL) in patients with a glycated hemoglobin (HbA1c) less than 13% (6).”
BackgroundInfluentialSelf-citationSynergy to Reduce Emergency Department Visits for Uncontrolled Hyperglycemia
Magee, M., Nassar, C., Copeland, J., Fokar, A., Sharretts, J., Dubin, J., & Smith, M. S. (2013) · The diabetes educator · doi:10.1177/0145721713484593 · Cited by 15 · see citing works
“A more recently reported randomized study found that sulfonylurea with or without 10 units of insulin glargine improved blood glucose (BG) levels in type 2 diabetes patients discharged from the ED to the outpatient setting.(12) Type 2 diabetes is a chronic, complex medical condition that requires daily self-management…”
BackgroundFrom diabetes to diverse domains: the multifaceted roles of GLP-1 receptor agonists
Dave, B. P., Chorawala, M. R., Shah, I., Shah, N. N., Bhagat, S. U., Prajapati, B. G., & Thakkar, P. C. (2024) · Molecular Biology Reports · doi:10.1007/s11033-024-09793-y · Cited by 12 · see citing works
“When blood glucose levels are above 300 mg/dL or HbA1C > 10% or any of the above two characteristics are present, then insulin therapy should be generally initiated [16].”
Alsofiani, M., Batais, M., Aldhafiri, E., & Alzaid, A. (2021) · Diabetes & metabolic syndrome · doi:10.1016/j.dsx.2021.04.003 · Cited by 9 · see citing works
Shah, M., Adel, M., Tahsin, B., Guerra, Y., & Fogelfeld, L. (2020) · PLoS ONE · doi:10.1371/journal.pone.0231190 · Cited by 7 · see citing works
“In the subjects with T2DM, the pre- and post-prednisone values were statistically significant for the rise in AUC Glc, decrease in IGI and HOMA-%B.”
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“A similar prevalence of male patients was also observed in other studies on severe hyperglycaemia (37).”
ResultLee, K., Jin, H. Y., Kim, Y., Kim, S. S., Cho, E.-H., & Park, T. (2022) · Medicine · doi:10.1097/md.0000000000028823 · Cited by 5 · see citing works
“On the other hand, patients with uncontrolled hyperglycemia associated with T2D can be effectively treated with SU.([16]) Another meta-analysis revealed that second- and third-generation SUs do not influence all-cause or cardiovascular mortality, but they decrease the risk of nonfatal macrovascular outcomes compared w…”
InfluentialComparison of two glycemic discharge goals in ED patients with hyperglycemia, a randomized trial.
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“At discharge, for patients not currently taking antihyperglycemic agents we recommended prescribing glipizide XL 10 mg daily [18].”
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Targeted Glycemic Control for Adult Patients With Type 2 Diabetes Mellitus in the Acute Care Setting
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“Recommendation 2: Metformin is recommended as the first line treatment option in people with T2MD and without established ASCVD, high-risk indicators for ASCVD, HF, or CKD (9, 17, 20-23).”
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- Authors
- Babu, A., Mehta, A., Guerrero, P., Chen, Z., Meyer, P. M., Koh, C. K., Roberts, R., Schaider, J., & Fogelfeld, L.
- Affiliations
- Rush University Medical Center (US)
- Lutheran Medical Center (US)
- University of Michigan (US)
- Corresponding author
- Babu, Ambika
- Meyer, Peter M.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2009-11
- Volume
- 15
- Issue
- 7
- Pages
- 696-704
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W2039159292
- Cited by
- 34
- References
- 23
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 6 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 2 · 2013: 1
- FWCI
- 0.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- type 2 diabetes, severe hyperglycemia, emergency department discharge, insulin glargine, sulfonylureas, beta-cell function, HOMA, early insulin response, glycemic control
- MeSH terms
- Insulin Glargine, Adult, Blood Glucose, Diabetes Mellitus, Type 2, Drug Administration Schedule, Female, Glipizide, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Treatment Outcome, Insulin, Long-Acting, Insulin-Secreting Cells
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