Causes of admission of diabetes mellitus patients on the medical wards at the university teaching hospital in Rwanda (Kigali university teaching hospital, Rwanda Military Hospital).

Abstract

Background

Diabetes Mellitus is associated with acute metabolic and chronic complications. It is known to the outpatient clinics for needing special care pathways as a sensitive disease. However, patients with Diabetes Mellitus are frequently admitted to the hospitals’ inpatient wards compared to the general population. There is little information about their reasons for admission and the outcome of care following their admissions in tertiary academic hospitals in Rwanda.

Aim: The aim was to identify reasons for admission to the hospitals’ wards among diabetic patients and to identify the outcome of inpatient care following admission.

Patients and Method: This a cross sectional study conducted at the University Teaching Hospitals of Kigali and Rwanda military hospital. It involves 127 participants with Diabetes Mellitus admitted between 1st January 2021 and 31 April 2021. The data were collected from patients’ files and were followed up from their admission time to their discharge from the hospital.

Results: Among the 127 participants included in this study, 59.4% were of female gender, 49.6% were of male gender. The majority (85%) were more than 45 years. The mean age was 59.8 years. The type 2 Diabetes Mellitus was more prevalent 92.9% while the patients with type 1 Diabetes Mellitus were 2.4%. The prevalent reasons for admission were classified as acute metabolic complications of diabetes (38.5%), and the commonest specific reason among acute metabolic complications was Diabetic Keto Acidosis; DKA (22.8%) followed by Hyperosmolar Hyperglycemic State; HHS (11.8%) and hypoglycemia (3.9%). The second reason for admission was in the category of infections (37%). Among the bacterial infections noted, the infection affecting the lungs was prevalent followed by the urinary tract infection. COVID-19 pneumonia was identified in 7.09% patients. Other reasons for admission were in the category of chronic complications of Diabetes Mellitus where hypertension was observed as a reason for admission in 22.8%, followed by chronic kidney disease 16.5% and Hypertension as a comorbidity in 59.1%. The mean in hospital stay was 12 days. The overall inpatient mortality rate in this study was 15%. Of all the parameters studied, hyperglycemic hyperosmolar state is outstandingly associated with inpatient mortality (OR=10.49, 95% CI: 3.19-34.49, p<0.001).

Conclusion: The main causes of admission were acute metabolic complications of Diabetes Mellitus followed by the infectious processes. Infections were the most triggers for admission observed in patients with hyperglycemic emergencies. Other significant causes of admission were in the group of chronic complications of Diabetes Mellitus, and on the top of the list we can cite uncontrolled hypertension and chronic kidney disease. A total of 15 % participants died in the hospital. Patients who presented in hyperglycemic hyperosmolar state were 10 times likely to die compared to those who did not present in the same clinical state (P -value <0.001).