Predictors and treatment outcome of hyperglycemic emergencies at Jimma University Specialized Hospital, southwest Ethiopia

Abstract

BackgroundDiabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) commonly known as hyperglycemic emergencies are the two most common life-threatening acute metabolic complications of diabetes. The objective of this study is to assess predictors and treatment outcome of hyperglycemic emergencies (HEs) among diabetic patients admitted to Jimma University Specialized Hospital (JUSH).MethodsIt is a three year retrospective review of medical records of patients admitted with HEs at JUSH. Patient demographics, admission clinical characteristics, precipitants, insulin used and treatment outcomes were extracted. Statistical analysis was done using student’s t test, Chi square test, and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p < 0.05.ResultsComplete data was available for 163 out of 421 patients admitted with HEs. The majority (62.6 %) were males. Mean age of patients was 36.6 ± 15.9 years. About 64 % of patients had type 1 diabetes. About 93 % of the participants developed DKA. The most common precipitants of HEs were infections 95 (59 %), non-compliance to medications 52 (32.3 %), and newly diagnosed diabetes 38 (23.6 %). Recurrent hyperglycemia, hypoglycemia and ketonuria occurred in 88 (54 %), 34 (20.9 %) and 31 (20.5 %) patients respectively. Mean amount of insulin used and duration of treatment till resolution of DKA were 136.85 ± 152.41 units and 64.38 ± 76.34 h respectively. The median length of hospital stay was 6 days. Mortality from HEs was 16 (9.8 %). Admission serum creatinine >1.2 mg/dL (P = 0.018), co-morbidity (P < 0.001) and sepsis (P = 0.014) were independent predictors of HEs mortality.ConclusionsInfections, non-compliance and new onset diabetes were the most common precipitants of HEs. Length of hospital stay and mortality were high. High use of insulin, recurrent hyperglycemia, hypoglycemia, and ketonuria were common during HEs management. Elevated serum creatinine, sepsis and co-morbidity are independent predictors of HEs mortality.

Treatment Outcome Of Hyperglycemic Emergency And Predictors In Ethiopia

“…HHS was the major HE case. This nding goes in line with studies from Nigeria and Taiwan (15,(24)(25)(26)(27) but stands against a study reported that DKA was the commonest HE (22). The higher prevalence of HHS in our study might be explained by the fact that the majority of the study participants were T2DM patients, and that HHS often raids patients with uncontrolled T2DM (28).…”

“…The rate of comorbidity in our study was 32.4%. This rate is higher than the 22.1% reported by a study from Jimma (22). The relatively higher proportion of known DM patients in our study might justify this higher prevalence of comorbidity.…”

“…Africa (22,34). The inconsistency may be due to the difference among the settings in the effective and e cient management of DM patients presenting with HE.…”

“…There are few studies on patients with DKA (19)(20)(21). However, a single study assessed DKA and HHS pooled mortality and patient's hospital stay duration (22). Thus, our study aims to assess the treatment outcome of HE and predictors among DM patients hospitalized with DKA and HHS at Hiwot Fana Specialized University Hospital (HFSUH), Ethiopia.…”

Treatment Outcome of Diabetic Ketoacidosis Among Patients Atending General Hospital in North-West Ethiopia: Hospital Based Study

“…In Ethiopia, mortality from hyperglycemic emergencies is not well documented but comparatively high in few studies. A study done in Jimma found a mortality rate of 9.8 % from hyperglycemic emergencies (12).Socioeconomic factors, particularly the cost and unreliability of insulin supplies are the major obstacles to the control of diabetes and prevention of ketoacidosis in Ethiopian patients (13). Mortality rate is lower in patients that received appropriate treatment and management of precipitating factors (14).…”