Magnitude, risk factors and economic impacts of diabetic emergencies in developing countries: A systematic review

BACKGROUND

Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS) and severe hypoglycemia are considered as the life-threatening diabetic emergencies of diabetic patients worldwide. As the prevalence of diabetes grows in developing countries, so too does the impact of these costly human and economic complications. Noticeable scarcity of data concerning the magnitude, the cost expenditures as well as well unidentified predictors of these complications made the management more difficult in the resource limited health care settings. Thus, this systematic review aimed to assess the magnitude, risk factors and economic impacts of diabetes emergencies among diabetic patients in the developing countries.

METHODS

Following PRISMA (2020) guidelines, databases of PubMed, EMBASE, Cochrane and Scopus were searched for studies reporting on prevalence, risk factors, and direct costs of diabetes emergencies published in English from 2000 to 2023. Forty eligible studies were extracted and retrieved using manual data extraction form and automation tools. Studies were analyzed and combined in a narrative synthesis. The estimations of direct cost expenditure were standardized to 2023 USD.

RESULT

A comprehensive examination was conducted on the 40 eligible studies, with the majority originating from African sources. The review shows the prevalence of diabetic emergencies; DKA episodes in the range of (3.8%-73.4%), HHS (0.9%-58%) and Severe hypoglycemia (3.3%-64.7%) per year in the developing countries. Infection, new onset of the diabetes, and non-compliance to medications and diets were reported as the most common risk factors of theses diabetic emergencies. Besides, the costs of hospitalization taken from the patients' perspective, that were associated per one diabetic emergency event per patient was reported in the range of 105-230 USD in the developing countries.

CONCLUSION

The rising prevalence of diabetic emergencies in poor nations, where infections, non-compliance, and new onset of diabetes are major causes, highlighted the urgent need for preventative interventions. Identifying high-risk individuals is crucial for implementing tailored strategies to reduce emergency visits and hospital admissions. The significant economic burden of these emergencies exacerbates the strain on already limited healthcare resources. In order to enhance health outcomes and lessen the financial strain on healthcare systems in these areas, preventive strategies must be incorporated into diabetes management programs.

Incidence and determinants of diabetic ketoacidosis among people with diabetes in Woldiya comprehensive specialized hospital, Ethiopia: a retrospective cohort study

INTRODUCTION

Diabetic ketoacidosis is an acute complication of diabetes mellitus that is characterised by hyperglycemia, acidosis, and ketonuria. Diabetes is the most challenging public health problem in the twenty-first century for both developed and developing countries.

OBJECTIVE

To assess the incidence of Diabetic ketoacidosis and its determinants among adult people with diabetes at an Ethiopian Hospital.

METHOD

An institution-based retrospective cohort study was conducted among 390 adult people with diabetes attending services at Wolida Comprehensive Specialized Hospital. The consecutive sampling method was used to select study participant charts. Data were collected using a checklist prepared from different literature. The data were entered into EPI data version 4.6.0.5 and exported to STATA version 14.0 for further analysis. The Wiebull model was the best fitted model that was selected using the log-likelihood ratio method and the Akakian information criterion. Hazard ratios with their 95% confidence interval and p-value were computed.

RESULT

From the total 405 charts reviewed, 390 adult charts were included for analysis. A total of 121 DKA occurred from 5471 person-months of observation. The overall incidence rate of diabetic ketoacidosis was found to be 2.2 per 100 person-months (95% CI: 1.8- 2.6). Being urban dweller (AHR: 0.59, 95% CI: 0.36-0.99), having no family history of DM (AHR: 0.55, 95%CI: 0.31-0.97), presence of infection (AHR: 2.60, 95%CI = 1.06-6.39), having of any comorbidities (AHR: 4.31, 95% CI: 1.70-10.90), and having poor glycemic control (AHR: 7.45, 95% CI: 3.84-14.47) were significant determinants.

CONCLUSION AND RECOMMENDATIONS

The overall incidence of diabetic ketoacidosis in study area was relatively high. Poor glycemic control, the presence of infection, and comorbidity were determinants of diabetic ketoacidosis. There is a need to have close follow-up of people with diabetes who have comorbidity, infection, and poor glycemic control.

Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia

BACKGROUND

Diabetic ketoacidosis (DKA) is one of the most common public health problems and is still a major child killer in sub-Saharan African countries, particularly Ethiopia. There are limited and inconclusive data in Amhara regional state; moreover, predictors for the incidence of DKA were not investigated before. Therefore, this study aimed to assess the frequency of DKA and its determinants among pediatric diabetes mellitus patients in public hospitals in northwest Ethiopia.

METHODS

An institutional-based retrospective follow-up study was conducted from September 2015 to February 2018 at selected public hospitals in northwest Ethiopia. A simple random sampling method was used to select 389 study subjects. Statistical analysis was done by R-studio version 1.1.4. Akakia's information criteria was used for model comparison and the negative binomial regression model was fitted to identify determinants for the frequency of DKA. An adjusted incidence rate ratio with 95% confidence interval was used to declare statistical significance.

RESULTS

The average frequency of DKA was 1.01 per individual. The incidence rate of DKA was increased among diabetes mellitus patients with an infection (adjusted incidence rate ratio (AIRR) = 1.41, 95% CI = 1.05-2.14), heart diseases (AIRR = 4.1, 95% CI = 1.17-14.68), treatment discontinuation (AIRR = 2.91, 95% CI = 2.02-4.22), low level of sodium (AIRR = 1.88, 95% CI = 1.22-2.89) and low dose of treatment at baseline (AIRR = 0.96, 95% CI = 0.94-0.97).

CONCLUSION

Having an infection, heart diseases, taking a low dose of treatment, a low sodium level, and treatment discontinuation were the factors that increase the frequency of DKA.

Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes

AIMS

To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND).

METHODS

In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA-during follow-up according to the most recent episode-or ND.

RESULTS

At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression.

CONCLUSIONS

HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.