Keywords
decompensations
ketoacidosis
hypoglycemia
hyperosmolar
How to Cite
Abstract
Introduction: Diabetes acute decompensations appear frequently. The most common presentation is CAD and hypoglicemia with roughly 145.000 cases a year. Hyperosmolar state (HOS) presents itself in less than 1% cases. These demand an appropriate and timely recognition and treatment.
Mortality attributable to CAD is 2% in general hospitals and 5% in specialized hospitals. Mortality in HOS is larger, between 15%-70%. This can be attributed to the type of population (advanced age) and to its comorbilities. Mortality due to hypoglicemia is around 20% in insulinized patients vs. 4.5% in non insulinized patients. In Colombia, very little is known about the behaviour of acute decompensations in our patients.
Objective: To describe demographic and clinical characteristics of patients suffering from Diabetes Mellitus 2 who have been admitted with acute decompensations to the internal medicine service in Hospital San José between October 2010 and August 2013.
Methods: Descriptive study which monitored a group of patients admitted to Hospital San José with Diabetes Mellitus type 2 and acute decompensations, recruited between October 2010 and August 2013.
Results: From a total of 470 patients, 45 presented cetoacidosis (9.5%), hyperosmolar state (4%) and hypoglicemia (9.5%). 76% had no decompensation when admitted. Time of evolution of the sickness was 9.7 years for cetoacidosis and for HOS and hypoglicemia approximately 13 years. Only 57% had access to self monitoring.
Women present decompensation more often: 48.9% do in cetoacidosis, 52.6% in hyperosmolar state, 64% in hypoglicemia. The most common reason for admittance is miscelaneous 39.4% followed by infections ( 35%). Most were out of metabolic control hba1c > 9%. 62% cetoacidosis, 68% hyperosmolar state, 33% hypoglicemia. About chronic complications, they were mostly microvascular especially in the hypoglicemic group. Mortality was more present in the CAD 6.6%, followed by hypoglicemia 4.4%. 30% had access to a glucometer for self monitoring. About 15% had suspended treatment for non adherence or non access to health.
Conclusion: The implementation of optimal programs based in a better metabolic control and individual treatment according to each case, the patient’s level of education, self monitoring and a multidisciplinary team can all serve to diminish the presence of acute decompensations. Mortality, when presented, lowers its levels if the cause of precipitation is timely and correctly managed.
References
2. Piniés J.A. Complicaciones agudas y crónicas, un riesgo que debe ser evitado. Rev. Esp Econom Salud 2008;7(2):64-67 descripcion adicional sobre la pagina en IDF http://www.Diabetesatlas.org/es/content/morbilidad-y-mortalidad y en http://www.idf.org/diabetesatlas/regional-overview.
3. Diaz-Apodaca BA, Ebrahim S, McCormack V, de Cosio FG, Ruiz-Holguin R. Prevalence of type 2 diabetes and impaired fasting glucose: cross-sectional study of multiethnic adult population at the United States-Mexico border. Rev Panam Salud Publica 2010 Sep;28(3):174-81.
4. Schargrodsky H, Hernandez-Hernandez R, Champagne BM, Silva H, Vinueza R, Silva Aycaguer LC, et al. CARMELA: assessment of cardiovascular risk in seven Latin American cities. Am J Med 2008 Jan;121(1):58-65.
5. Aschner P. Síndrome Metabólico en una Poblaciòn Rural y una Poblaciòn Urbana de la Región Andina Colombiana. Revista Med - Universidad Militar Nueva Granada 2007 Jul 1;15(002):154-62.
6. Alayòn A, Alverar C. Prevalencia de desórdenes del metabolismo de los glúcidos y perfil del diabético en Cartagena de Indias (Colombia), 2005. Salud Uninorte Barraquilla (Colombia) 2011;22(1):20-8.
7. Villegas, A. El control de la diabetes mellitus y sus complicaciones en Medellín, Colombia, 2001-2003. Rev Panam Salud Publica [online]. 2006, 20; (6):393-402.
8. Guillermo Umpierrez, Mary Korytkowski Diabetic emergencies — keto- acidosis, hyperglycaemic hyperosmolar state and hypoglycaemia, Nat Rev Endocrinol. 2016.
9. Agency for Healthcare Research and Quality. Databases and related tools from the healthcare cost and utilization Project (HCUP) [article online]. National Center for Health Statistics, Centers for Disease Control. Available from www.hcup-us.ahrq.gov/reports/statbriefs. Accessed 24 January 2009.
10. Kitabchi, A. E., Umpierrez, G. E., Miles, J. M. & Fisher, J. N. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 32, 1335-1343 (2009).
11. Ronald VN. Hyperglycemic crisis. The Journal of Emergency Medicine. 2103 Vol. 45, No. 5, pp. 797-805-9.
12. Ministerio de Salud - Dirección General de Promoción y Prevención, Guía de atención de la diabetes tipo II.
13. The United Kingdom Prospective Diabetes Study Group: U.K. Prospective diabetes study.
14. Geller, a. i. et al. national estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. Jama Int. Med. 174, 678-686 (2014).
15. Krikorian, A., Ismail-Beigi, F. & Moghissi, E. S. Comparisons of different insulin infusion protocols: a review of recent literature. Curr. Opin. Clin. Nutr. Metab. Care 13, 198-204 (2010).
16. Umpierrez, G. E. et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care 30, 2181-2186 (2007).
17. Feliciano Jhon. Mortalidad por diabetes mellitus en Colombia desde 2004-2010, Asociación Latinoamericana de Diabetes, ALAD N3 vol 4, 97-105 (2014).
18. Kitabchi, A. E., Umpierrez, G. E., Miles, J. M. & Fisher, J. N. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 32, 1335-1343 (2009).
19. Centers for Disease Control and Prevention. Diabetes data & trends. [online] http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm (2015).
20. Ox, C. S. et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 38, 1777-1803 (2015).
21. Cryer, P. E. Hypoglycemia-associated autonomic failure in diabetes: mal- adaptive, adaptive, or both? Diabetes 64, 2322-2323 (2015).
22. Geller, A. I. et al. National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Int. Med. 174, 678-686 (2014).
23. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med 2013;368:1613-1624.
24. Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care 1995;18:258-268 29. Estacio RO, McFarling E, Big- gerstaff S, Jeffers BW, Johnson D, Schrier RW. Overt albuminuria predicts diabetic retinopathy in His- panics with NIDDM. Am J Kidney Dis 1998;31: 947-953.
25. Leske MC, Wu S-Y, Hennis A, et al.; Barbados Eye Study Group. Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology 2005;112:799-805.
26. Chew EY, Davis MD, Danis RP, et al.; Action to Control Cardiovascular Risk in Diabetes Eye Study Research Group. The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study. Ophthalmology 2014; 121:2443-2451.
27. Freeman R. Not all neuropathy in diabetes is of diabetic etiology: differenial diagnosis of diabetic neuropathy. Curr Diab Rep 2009;9:423-431.
Authors must state that they reviewed, validated and approved the manuscript's publication. Moreover, they must sign a model release that should be sent. A copy may be reviewed here