Clinical Outcomes and Its Predictors among Patients With Diabetes Mellitus Admitted To Jimma University Medical Center: A Prospective Observational Study

Abstract

Background: Diabetes Mellitus (DM) is one of the largest health emergencies of the 21st century and among the top ten causes of death in adults globally in 2017. Although Ethiopia has been challenged by the growing prevalence of DM, important data regarding in-hospital complications and rates of 30-day readmission are lacking. Besides, data on in-hospital mortality rate among admitted diabetic patients in Ethiopia, including Jimma Medical Center (JMC), are also limited. Objective: To assess clinical outcomes and its predictors among DM patients admitted to JMC. Methods: A hospital-based prospective observational study involving 120 admitted diabetes patients from October 01, 2020, to June 30, 2021, was conducted in JMC in Ethiopia. Data were collected on variables related to the patient, disease, medication, and clinical outcomes. Data were entered into Epi-data version 4.6.0.4 for cleaning and exported to SPSS version 23.0 for analysis. Kaplan-Mayer and cox-regression were used to compare survival experience and to determine the predictors of clinical outcomes, respectively. Hazard ratios with its two-sided p value <0.05 was considered to declare statistical significance. Result: Of 120 DM patients 81 (67.5%) were males. The over all in-hospital mortality was 16(13.34%). Twenty-two patients (18.3%) developed in-hospital complications and 20(19.23%) were readmitted within 30-day of index discharge. Urban residence (AHR: 3.46; 95%CI: [1.12, 9.81]), Age (AHR: 1.03; 95%CI: [1.001, 1.059]), Diabetic Ketoacidosis (DKA) (AHR: 5.01; 95%CI: [1.12, 21.88]), and patients who had: five (5) comorbidities (AHR: 9.65; 95%CI: [1.07, 19.59] and six (6) comorbidities (AHR: 14.02; 95%CI: [1.74, 21.05]) were significant predictors of in-hospital mortality. The use of non-antidiabetic medications such as statins, ASA, antihypertensive medications before admission was remained protective (AHR: 0.135; 95%CI: [0.04, 0.46]). Female gender (AHR: 3.71; 95%CI: [1.36, 10.3]) and renal disease (AHR: 4.48; 95%CI: [1.26, 15.93]) were significant predictors of unplanned 30-day rate of readmission. Conclusion: This study showed that in-hospital mortality rate was noticeably high. About 1/6th of patients developed in-hospital complications while 1/5th of discharged patients experienced 30-day readmission. Urban residence, age, DKA, and having comorbidities (5 and 6) were predictors of mortality, and non-antidiabetic medications use before admission was protective. Female gender and renal disease were predictors of 30-day readmission. The above-identified predictors need attention to reduce in-hospital mortality, in-hospital complications, and 30-day readmission by JMC.