Citations

OBJECTIVE To evaluate the impact of community paramedic (CP)-delivered, in-home diabetes self-management education and support (DSMES) for adults with poorly managed diabetes. RESEARCH DESIGN AND METHODS In a pragmatic, single-arm pilot trial, adults with HbA1c ≥9% and a recent emergency department or hospital visit received a 1-month CP-led DSMES intervention. Outcomes included HbA1c, health care engagement, and patient-reported satisfaction. RESULTS Seventy participants (median age 61 years, 50% rural, 84% with type 2 diabetes) completed the intervention. HbA1c declined from 9.8% to 8.2% at 4 months (P < 0.001). Engagement with primary care, endocrinology, and DSMES improved. Satisfaction was high (mean rating 9 out of 10). CONCLUSIONS CP-led DSMES improved glycemic management and care engagement in underserved populations. This scalable model warrants further study.

Optimal management of hyperglycemia during illness has been hindered by a lack of comprehensive sick-day guidance, particularly for adults with diabetes. Managing glycemia can be challenging during illness because of adaptive counterregulatory hormonal changes, acute stress of illness, altered dietary intake, and effects of medications. People with diabetes may be at risk for severe hypoglycemia and hyperglycemic crisis during illness unless mitigated by close monitoring and medication adjustment. This article provides practical guidance to health care professionals and people with diabetes for safe glycemic management during illness, including considerations for insulin and noninsulin medications, use of insulin technologies, prevention of hypoglycemia and ketoacidosis, steroid use, and pregnancy.