The epidemiology, risk factors and outcomes of hyperglycemic emergencies at university teaching hospital of Kigali in emergency department

Abstract

Background Diabetes mellitus (DM) is a chronic condition that occurs when there is a high level of glucose in the blood. This can be due to total lack or insufficiency of the hormone called insulin produced by the body or when it is ineffectively used by the body. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two main serious complications of decompensated diabetes, and they are potentially fatal. However, there is limited data about diabetic complications in Rwanda, which is vital to help inform the Ministry of Health about effective health policies to prevent complications. The objective of this study was to evaluate the epidemiology, risk factors and outcomes of hyperglycemic emergencies at University Teaching Hospital of Kigali (CHUK) in the Emergency Department. Methodology This was a single-centered cross-sectional study evaluating epidemiology, risk factors, and outcomes of hyperglycemic emergencies at University Teaching Hospital of Kigali at Emergency Department from 1st September 2020 to 28th February 2021. Variables of interest included patient demographics such as gender, material status, ubudehe category, health insurance, medical histories including time since DM diagnosis, and type of hyperglycemic emergencies. Patient outcomes were retrospectively abstracted from Open Clinic, an online electronic database for patient history files. Data processing and analysis were carried out with the help of Microsoft Excel 2013 and StataSE 15. Results The total number of patients enrolled in this study was 44, with a female predominance (61.4%). Age ranged between 18 and 81 years, with the median age of 43.5 (IQR: 33, 61.5) years. The majority of patients came from home (50%) and most patients were using Mutuelle de Santé as medical insurance (77.3%). Considering the time of DM diagnosis, the majority were newly diagnosed with DM (36.4%), followed by those diagnosed with DM in less than five years (27.3%). This study showed that DKA was seen in 23 patients (52.3%) while HH) was seen in 21 patients (47.7%). iv This study showed that the most common risk factor of hyperglycemic emergencies is infection (33.3%) and the other common risk factors are newly diagnosed DM (20%) and the combination of newly diagnosed DM and infection (20%). Mortality was 34.1% and was more prevalent in DKA compared to HHS patients. The median length of stay in the hospital was 11 (IQR: 6.5, 17.5) days for survived patients and 4 (IQR: 2, 10) days for died patients. In unadjusted analysis, HHS patients had lower odds of dying from a hyperglycemic emergency compared to DKA patients (OR = 0.27, 95% CI 0.07-1.00, p = 0.05). Mortality was found to be significantly associated with type of medical insurance (p = 0.005). Conclusion This study showed that the most common risk factors of HEs are infections and newly diagnosed DM. Overall, mortality was high among this cohort. Given that those risk factors are preventable, measures should be put in place to educate the community about the routine screening of DM and early consultation. This may be able to reduce the prevalence and outcome of hyperglycemic emergencies in Rwanda