Predictors and Treatment Outcome of Hyperglycemic Emergencies at Jimma University Specialized Hospital, Southwest Ethiopia

Abstract

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most common life-threatening acute metabolic complications of diabetes. Objective: to assess predictors and treatment outcome of hyperglycemic emergencies (HEs) among adult and adolescent diabetic patients admitted to Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. Methods: A three year retrospective review of medical records of diabetic patients admitted with HEs at JUSH was done. The information extracted included patient demographics, admission clinical characteristics, precipitants, insulin used and treatment outcomes. Statistical tests used were student’s t-test, chi-square test, and binary logistic regression with α set at 0.05. Results: Complete data was available for 163 out of 421 patients admitted with HEs, 102 (62.6%) males and 61 (37.4%) females. Mean age of patients (years) was 36.6 ± 15.9 (range 15- 84). The majority (63.8%) of patients had type 1 diabetes and 74 (45.4%) were newly diagnosed at admission. DKA was noted in 151 (92.6%) subjects. 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 (in DKA patients) 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 hours respectively. The average length of hospital stay was 9.4 days (range 1 to 59). Mortality rate of patients from HEs was 16 (9.8%). Independent predictors of HEs mortality were admission serum creatinine >1.2 mg/dl (AOR=5.86, 95%CI: 1.36-25.28, P=0.018), comorbidity (AOR=15.26, 95%CI: 3.67-63.41, P<0.001) and sepsis (AOR=9.83, 95%CI: 1.59- 60.79, P=0.014). Conclusion: DKA was the major presentation of HEs. Infections, non-compliance and new onset diabetes were the most common precipitants of HEs. Length of hospital stay and mortality from HEs were high. High use of insulin, recurrent hyperglycemia, hypoglycemia, and ketonuria were common problems noted in HEs management at the hospital. Elevated serum creatinine, sepsis and co-morbidity were independent predictors of HEs mortality. Generally, prevention, early detection and proper management of HEs at the hospital should be given due consideration.