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Background: Diabetes and pre-diabetes are significant risk factors for acute coronary syndrome (ACS) and acute primary stroke (APS). Dysglycemia in any context is under-diagnosed or identified late in resource-poor countries such as in sub-Saharan Africa (SSA), especially when the patient is not known to have pre-morbid diabetes. Materials and methods: We conducted a prospective cross-sectional study at the Aga Khan University Hospital, Nairobi. Inclusion criteria: consenting adults ≥ 18 years admitted with ACS/APS during the period April 2021- February 2022 inclusive. HbA1C was used to determine the glycemic status. Definition of diabetes and pre-diabetes was based on the American Diabetes Association guidelines. Results: From a total of 211 patients [144 (81.2%) of African race], the median age of the patients was 58 (49–68) years with a male to female ratio of 2.5:1. 47.4% (n = 100) had ACS and 52.6% (n = 111) had APS. The prevalence of dysglycemia was 68.2% (95% CI: 61.5%-74.5%) with the prevalence of pre-diabetes being 30.3% (64/211) and type 2 diabetes 37.9% (80/211). Of the patients with dysglycemia, 47.9% (69/144) had a new diagnosis. The average duration of diabetes in patients known to have the condition was 6 years, with a median HbA1C of 8.55 (inter-quartile range 7.21–10.47). 69.4% (137/211) had hypertension as a comorbidity. Among the patients with dysglycemia 73% (101/144) also had hypertension. In the multivariate analysis, age OR 1.05 (1.02–1.08) 95% CI p-value 0.003 and triglyceride levels OR 2.44 (1.44–4.48) 95% CI p-value 0.002 were significantly associated with dysglycemia. Conclusion: This study shows a remarkably high prevalence of dysglycaemia in patients with ACS/APS. The new diagnosis of pre-diabetes prevalence was comparable to diabetes in these patients, adding to the evidence that prediabetes portends significant cardiometabolic consequences and effects over and above the development of type 2 diabetes.

Background Diabetic Ketoacidosis (DKA) is a potentially life-threatening diabetic emergency requiring prompt recognition and care. The prognosis of DKA has improved over time with the availability of evidence-based protocols and resources. However, in Kenya, there are limited resources for the appropriate diagnosis and management of DKA, and these are limited to tertiary-level referral facilities. This study aimed to review the clinical presentation, management, and outcomes of adult patients admitted with DKA at the Aga Khan University Hospital, Nairobi, over five years and assess differences in these parameters before and during the COVID-19 pandemic. Methods This was a retrospective study of DKA admissions from January 2017 to December 2021. Patient data were retrieved from the medical records department using ICD-10 codes, and individual details were abstracted on clinical presentation, management, and outcomes of DKA. Comparisons were made between pre-COVID-19 and during COVID-19 durations. Results 150 patients admitted with DKA were included (n = 48 pre- COVID-19, n = 102 during COVID-19 (n = 23 COVID-19 positive, n = 79 COVID-19 negative)). Median age was 47 years (IQR 33.0, 59.0), median HbA1C was 12.4% [IQR 10.8, 14.6]), and most patients had severe DKA (46%). Most common DKA precipitants were infections (40.7%), newly diagnosed diabetes (33.3%) and missed medication (25.3%). There was a significant difference in pulmonary infections as a DKA precipitant, between the pre- COVID and during COVID-19 pandemic (21.6% during COVID-19 versus 6.3% pre- COVID-19; p = 0.012). Median total insulin dose used was 110.0 units [IQR 76.0, 173.0], and a 100% of patients received basal insulin. The median length of hospital stay was 4.0 days [IQR 3.0, 6.0] and time to DKA resolution was 30.0 hours [IQR 24.0, 48.0]. There were 2 deaths (1.3%), none directly attributable to DKA. Severity of DKA significantly differed between pre- COVID-19, COVID-19 positive and COVID-19 negative DKA (52.2% of COVID-19 positive had moderate DKA compared to 26.6% of COVID-19 negative and 22.9% of Pre-COVID-19 (p = 0.006)). Conclusion These findings indicate that even in developing regions, good outcomes can be achieved with the appropriate facilities for DKA management. Clinician and patient education is necessary to ensure early detection and prompt referral to avoid patients presenting with severe DKA. Exploratory studies are needed to assess reasons for prolonged time to DKA resolution found in this study.