ED Alert Boosts A1c Testing, Not Glycemic Control

TOPLINE: 

An emergency department (ED)–based alert led to a higher rate of A1c testing among patients with diabetes overdue for routine monitoring but did not significantly improve long-term glycemic control.

METHODOLOGY:

• In this retrospective study, the researchers analyzed 348,490 ED visits by patients with diabetes from January 2017 to September 2023.
• In November 2017, an alert was added to the ED Information System for 13,609 patients with diabetes within the health system who were noncompliant with routine biannual A1c testing. The intervention targeted patients already undergoing blood tests.
• The primary outcome was the ordering of an A1c test, and the secondary outcome was the change in A1c levels on follow-up testing (> 30 days after the index test).

TAKEAWAY:

• Following the alert’s implementation, physicians ordered A1c tests for 1442 noncompliant patients.
• A1c testing among noncompliant patients increased from 1.5% to 12.1% (P < .001), peaking at 22.5% in the first year but declining to 5.1% by 6 years.
• Among patients with follow-up data, the average decrease in A1c was −0.42, which was not significantly different from the preintervention decrease of −0.60 (P = .40).
• Only 15% of noncompliant patients achieved the target A1c level (< 7.0), whereas 26% of the general ED population reached this goal (P = .013).

IN PRACTICE:

“A targeted ED intervention was associated with increased testing for A1c; however, the effects decreased over time without educational communication,” the authors wrote. “While the program demonstrates operational feasibility, it does not appear to result in significant improvements in A1c levels relative to the overall ED population,” they added.

SOURCE:

The study was led by Daniel L. Shaw, MD, MCSO, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston. It was published online on May 15, 2025, in The Journal of Emergency Medicine. 

LIMITATIONS:

The study’s retrospective design and reliance on a single institution’s database limited generalizability. The classification of “noncompliance” might have misrepresented patients early in the calendar year. The COVID-19 pandemic during the study period could have affected ED use, follow-up, and testing compliance.

DISCLOSURES:

This study did not receive any outside funding or sponsorship. The authors did not disclose any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.