Clinical profile and hospitalization outcome of patients admitted with hyperglycemic emergencies at tertiary hospitals in Rwanda.

Abstract

Objective: This study aims to evaluate the clinical profile and hospitalization outcome of patients admitted with hyperglycemic emergencies at tertiary hospitals in Rwanda.

Materials and Methods: This was a prospective observational study conducted from November 2019 to November 2020. Data on socioeconomic status, demographics, clinical profile, type of diabetes and duration, prior treatment, laboratory data, precipitating factors if known were recorded. Outcome measures were length of hospital stay and inhospital death.

Results: One hundred forty-three patients were included in the study, seventy-nine (55%) were female, thirty-five (25.2%) had type 1 diabetes mellitus, one hundred and five (73.4%) had type 2 diabetes and two (1.4%) patients were unclassified. Most of the study subjects were middle-aged (56%) and most of them originated from Kigali city and southern province 40 (28%), 63(44.1%) respectively.

Of 143 patients, 85 were diagnosed with DKA, 51 were diagnosed with HHS, and 7 were unclassified, sixty-seven patients (46.9%) were newly diagnosed with diabetes mellitus (DM). abdominal pain and kussmal breathing were most observed in DKA in relation to HHS patients 26 (78.8%) vs 6 (18.2%) and 41 (48.2%) vs 4 (7.8%) with significant p values (p = 0.035, p<0.001) respectively. There was a statistically significant difference between DKA and HHS in median of serum blood sugar, mean serum Potassium and median serum Chloride (447 vs 635), (4.1 ± 1.0 vs 4.1 ± 0.9), (105.1 vs 97.0) with p values (p = <0.001, p =0.034, p =0.019) respectively. The leading precipitating factors were infect ions 56(34.5%) newly diagnosed DM 48 (29%) and poor drug adherence 31 (19%).

Having infections at admission, raised serum creatinine, comatose state, history of poor drug adherence and hypernatremia were independent predictors of mortality, the overall mortality rate among recruited patients was 27.9%(40 ∕143).The median hospital stay was 11 days ranging from less than 1 day to 103 days.

Conclusion: Nearly half of the patients who presented with DKA and HHS had no previous diagnosis of DM; most of the patients come from urbanized areas. Infection, poor drug adherence, and newly diagnosed DM were the leading precipitating factors, the mortality rate was high.