Determinants of diabetes ketoacidosis among diabetes mellitus patients at North Wollo and Waghimra zone public hospitals, Amhara region, Northern Ethiopia

Behind the Hospital Ward: In-Hospital Mortality of Type 2 Diabetes Mellitus Patients in Indonesia (Analysis of National Health Insurance Claim Sample Data)

The rising global prevalence of diabetes mellitus, a chronic metabolic disorder, poses significant challenges to healthcare systems worldwide. This study examined in-hospital mortality among patients diagnosed with non-insulin-dependent diabetes mellitus (NIDDM) of ICD-10, or Type 2 Diabetes Mellitus (T2DM), in Indonesia, utilizing hospital claims data spanning from 2017 to 2022 obtained from the Indonesia Health Social Security Agency or Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. The analysis, which included 610,809 hospitalized T2DM patients, revealed an in-hospital mortality rate of 6.6%. Factors contributing to an elevated risk of mortality included advanced age, the presence of comorbidities, and severe complications. Additionally, patients receiving health subsidies and those treated in government hospitals were found to have higher mortality risks. Geographic disparities were observed, highlighting variations in healthcare outcomes across different regions. Notably, the complication of ketoacidosis emerged as the most significant risk factor for in-hospital mortality, with an odds ratio (OR) of 10.86, underscoring the critical need for prompt intervention and thorough management of complications to improve patient outcomes.

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.

Burden of diabetic ketoacidosis among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to assess the magnitude and determinants of diabetic ketoacidosis (DKA) among patients with diabetes mellitus (DM) in Ethiopia.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

Age 15 and above all patients with diabetes with the diagnosis of DKA in Ethiopia DATA SOURCE: PubMed/MEDLINE, Cochrane Library, Science Direct, HINARI, Google Scholar and grey literatures were accessed to find relevant articles. Studies that have been conducted and reported in English language, articles with an available full-text, and observational studies were included. The task of searching sources was carried out from all stated electronic databases performed during 15 April-29 April 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

Eligible studies were critically appraised by three independent reviewers for methodological quality in the review using standardised critical appraisal instruments from Joanna Briggs Institute (JBI) for observational studies. After the finally extracted studies were exported, systematic review and meta-analysis were conducted using Unified Management, Assessment and Review of Information (JBI SUMARI) (JBI, Adelaide, Australia) and STATA V.17 software. Sensitivity tests were done, and funnel plot inspections with Egger's test were used to check for publication bias.

RESULT

From a total of 19 studies with 6498 study participants, the pooled prevalence of DKA among patients with DM in Ethiopia was 30.92% (95% CI 29.96 to 31.89) with a significant statistical heterogeneity (I2=99.2, p=<0.001). Sensitivity analysis suggested that three studies showed deviations from the estimated pooled prevalence. A funnel plot inspection and Egger's test indicated the absence of a publication bias.

CONCLUSION

This systematic review and meta-analysis revealed that the prevalence of DKA among patients with DM in Ethiopia was 30.92%. Besides, different behavioural and clinical determinants of DKA among patients with DM were identified. However, further studies should be conducted, particularly on the possible determinants of DKA, and different stakeholders should be engaged to minimise its burden.

Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis

BACKGROUND

The increasing prevalence of diabetic ketoacidosis (DKA) related admissions poses a significant burden on the healthcare systems globally. However, data regarding the predictors of healthcare resource utilization in DKA is limited and inconsistent. This study aimed to identify key predictors of hospital length of stay (LOS), readmission and recurrent DKA episodes.

METHODS

We undertook a retrospective cross-sectional analysis of all DKA admissions from 2015 to 2021 across four hospitals in Qatar. The primary outcomes were the length of stay (LOS), 90-day readmission and 6-month and 1-year DKA recurrence.

RESULTS

We included 922 patients with a median age of 35 years (25-45). 62% were males with type-1 diabetes-mellitus (T1DM) and type-2 DM (T2DM), present in 52% and 48% of patients. The median LOS was 2.6 days (IQR 1.1-4.8), and the median DKA resolution time was 18 h (10.5-29). Male-gender, new-onset DM, higher Charlson Comorbidity Index (CCI), lower haemoglobin, sodium and potassium, higher urea, longer DKA duration and MICU admission predicted a longer LOS in a multivariate regression analysis. None of the factors were significantly associated with 90-day readmission. Patients with pre-existing T1DM were more likely to have a six-month DKA recurrence than pre-existing T2DM. Patients with a 6-month DKA recurrence, female gender and T1DM had higher odds of 12-month recurrence, whereas a consult with a diabetes educator at the index admission was associated with decreased odds of recurrence.

CONCLUSIONS/INTERPRETATION

This is the most extensive study from the Middle-East region reporting on LOS, readmissions and the recurrence of DKA. Results from this study with a diverse population may be valuable for physicians and healthcare systems to decrease the diabetes-related healthcare burden in DKA patients.

Incidence and predictors of hyperglycemic emergencies among adult diabetic patients in Bahir Dar city public hospitals, Northwest Ethiopia, 2021: A multicenter retrospective follow-up study

Background

Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome are the two commonly known life-threatening hyperglycemic emergencies of diabetes mellitus. Despite the growing hyperglycemic emergency impact among adult patients with diabetes, its incidence and predictors have not been well studied in Ethiopia. Thus, this study aimed to assess the incidence and predictors of hyperglycemic emergencies among adult patients with diabetes.

Method

A retrospective follow-up study design was conducted among a randomly selected sample of 453 adult patients with diabetes. Data were entered into EPI data version 4.6 and analyzed using STATA version 14.0. A Cox-proportional hazard regression model was fitted to identify the independent predictors of hyperglycemic emergencies, and variables having a p < 0.05 in the multivariable model were considered statistically significant.

Result

Among the total adult patients with diabetes included in the study, 147 (32.45%) developed hyperglycemic emergencies. Hence, the overall incidence of hyperglycemic emergencies was 14.6 per 100 person-years observation. The incidence of diabetic ketoacidosis was 12.5 per 100 person-years (35.6 and 6.3 among T1DM and T2DM, respectively). The incidence of the hyperglycemic hyperosmolar syndrome was 2.1 per 100 person-years (0.9 and 2.4 among T1DM and T2DM, respectively). The overall median free survival time was 53.85 months. Type 1 diabetes mellitus [AHR = 2.75, 95% CI (1.68, 4.51)], diabetes duration of ≥ 3 years [AHR = 0.33, 95% CI (0.21, 0.50)], recent acute illness [AHR = 2.99, 95% CI (2.03, 4.43)], presence of comorbidity [AHR = 2.36, 95% CI (1.53, 3.63)], poor glycemic control [AHR = 3.47, 95% CI (2.17, 5.56)], history of medication non-compliance [AHR = 1.85,95% CI (1.24, 2.76)], follow-up frequency of 2-3 months [AHR = 1.79,95% CI (1.06, 3.01)], and without community health insurance [AHR = 1.63, 95% CI (1.14, 2.35)] were significant predictors of hyperglycemic emergencies.

Conclusion

The incidence of hyperglycemic emergencies was high. Therefore, giving greater attention to patients with identified predictors could decrease the occurrence of hyperglycemic emergencies and related public health and economic impacts.