Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study

Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13 years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.

Assessment of clinical profiles, and treatment outcomesforchildren with diabetic ketoacidosis, in two hospitals selectedfromAddis Ababa, Ethiopia, 2020

Background: Type 1 diabetes mellitus (T1DM) is a common autoimmune disorder that often presents in children.In these patients, diabetic ketoacidosis (DKA) is one of the most common and serious acute complications, which is associated with significant morbidity and mortality. The study aimed to assess the clinical profiles and outcomes of children admitted with DKA. Objective: To assess the clinical manifestations and treatment outcomes of DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conducted on 175 pediatric diabetic ketoacidosis children,who were admitted to the emergency units of two hospitals in Addis Ababa from September 2015 to February 2020 and whose medical records contained complete pertinent data. Patients were between the ages of 0 to 12 years. Proportional samples were taken from each hospital and data was collected retrospectively using a formatted checklist. The data was checked for its inclusiveness and entered Epi Info. version 4.6 and then transferred into SPSS version 25 software for further analysis. Result: DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were above the age of 10. A high-income level of the caretakers was found to be protective against DKA during the diagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting in a mortality rate of 6.9%. Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DM at first presentation. The age of presentation and clinical symptoms of the studied participants were like other international studies. Community education regarding the signs and symptoms of childhood DM can further prevent the development of DKA. [Ethiop. J. Health Dev. 2022; 36(2):000-000]

Assessment of clinical profiles, and treatment outcomes for children with diabetic ketoacidosis, in two hospitals selected from Addis Ababa, Ethiopia, 2020

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors

COVID-19 and diabetic ketoacidosis: A case series at an urban district hospital in South Africa

Coronavirus disease 2019 (COVID-19) is associated with an increased prevalence and mortality from diabetic ketoacidosis (DKA) globally. With limited access to specialised care, most patients with DKA in South Africa are managed at district hospital level. This study describes the profile of patients admitted to a district hospital in South Africa with DKA and COVID-19 and examines associated risk factors encountered. Methods: This was a case series of all patients presenting to a district hospital with DKA and COVID-19 infection between July 2020 and July 2021. Data extracted included patients' demographic profiles, biochemical results, comorbidities and clinical outcomes. Results: The median age of the 10 patients admitted during the study period was 39 years old (±12), six of whom were male. The hemoglobin A1c (HbA1c) values on admission ranged from 9.7 to 13.8. Five of the patients had pre-existing type 2 diabetes mellitus (DM). Four of the known DM patients were on metformin only, and one was on biphasic insulin. Three patients had other pre-existing comorbidities, two patients with hypertension and one with human immunodeficiency virus (HIV). Three patients demised, two of whom were hypoxic on admission. Conclusion: Diabetic ketoacidosis appears more commonly in COVID-19 infected patients with type 2 DM and at a young age. Suboptimal glycaemic control was associated with DKA, and hypoxia was a strong predictor for mortality. Treatment inertia was evident in the known DM group, who were on monotherapy despite persistent hyperglycaemia. Greater vigilance is required to detect ketosis in type 2 DM and intensify therapy to improve glycaemic control.

Aspects cliniques et thérapeutiques du diabète de l'enfant à Ngaoundéré (Cameroun) / Clinical presentation and management of childhood diabetes at Ngaoundere City (Cameroon)

Objectif. L'étude visait à évaluer les aspects cliniques et thérapeutiques des enfants diabétiques suivis à l'hôpital régional de Ngaoundéré. Méthodes. Il s'agissait d'une étude transversale rétrospective descriptive conduite du 15 avril au 10 juillet 2021 à l'unité Changing Diabetes In Children (CDIC) de l'Hôpital Régional de Ngaoundéré. Les données sociodémographiques (l'âge, le sexe, la scolarité, la religion), cliniques (indice de masse corporelle, signes cliniques, antécédents familiaux, circonstance de découverte, complications du diabète, durée de la maladie) et thérapeutiques de 26 enfants diabétiques âgés de 8 à 20 ans et régulièrement suivis dans cette unité ont été analysées. Résultats. La population d'étude était constituée de 14 filles (53,8%) et de 12 garçons (46,2%). Les symptômes les plus fréquents observés étaient la polyurie (34,6%), l'amaigrissement et la polydipsie (38,5%). Les complications les plus fréquentes étaient, l'acidocétose (19,2%) lié à l'hyperglycémie chronique et l'hypoglycémie (57,7%) lié au traitement par insulinothérapie. En guise de traitement, 96,1% de ces patients étaient sous un schéma thérapeutique associant au quotidien une injection d'insuline d'action rapide (Actrapid) à deux injections d'insuline d'action intermédiaire (Insulatard ou Mixtard). Le taux moyen d'hémoglobine glyquée (9,27 ± 3,38%) traduisait un mauvais contrôle glycémique dans cette population. La proportion des patients contrôlés, c'est-à-dire, ceux qui avaient un taux d'hémoglobine glyquée inférieure ou égale à 7%, était plus faible chez les garçons (25%) comparés aux filles (42,9%). Conclusion. Nos données interpellent les différents acteurs impliqués dans la prise en charge du diabète de l'enfant, sur la nécessité d'amélioré la qualité de cette prise en charge

Objective. The study aimed at assessing the clinical and therapeutic aspects of diabetic children under follow-up at the Ngaoundere Regional Hospital. Methods. This was a descriptive retrospective cross-sectional study conducted from April 15 to July 10, 2021, at the Changing Diabetes In Children (CDIC) unit of the Ngaoundéré Regional Hospital. Sociodemographic data (age, sex, education, religion), clinical data (body mass index, clinical signs, family history, circumstance of discovery, complications of diabetes, duration of the disease), and therapeutic data of 26 diabetic children aged 8 to 20 and regularly followed in this unit were analyzed. Results. Our study population consisted of 14 girls (53.8%) and 12 boys (46.2%). The most common symptoms observed were polyuria (34.6%), weight loss, and polydipsia (38.5%). The most common complications were ketoacidosis (19.2%) related to chronic hyperglycemia and hypoglycemia (57.7%) related to insulin therapy. By way of treatment, 96.1% of these patients were on a therapeutic regimen combining a daily injection of fast-acting insulin (Actrapid) and two injections of intermediate-acting insulin (Insulatard or Mixtard). The average level of glycated hemoglobin (9.27 ± 3.38%) reflected poor glycemic control in this population. The proportion of controlled patients, that is to say, those who had a glycated hemoglobin level less than or equal to 7%, was lower in boys (25%) compared to girls (42.9%). Conclusion. Our data challenge the various actors involved in the management of childhood diabetes, on the need to improve the quality of this care.

Outcome of hyperglycemic emergencies in a tertiary hospital, South East, Nigeria

Background: Hyperglycemic emergency (HE) is typically represented by diabetic ketoacidosis, (DKA) and hyperosmolar hyperglycemic state (HHS). It is a common cause of hospitalization due to diabetes mellitus (DM) and is associated with considerable mortality. In South East Nigeria, there is a paucity of studies on the treatment outcome of HE, hence the need for this study. Objective: The aim and objective of the study were to determine the outcome of treatment of adult persons living with diabetes managed for HE at Federal Medical Centre (FMC), Umuahia. Materials and Methods: This was a prospective study in which 110 consecutive adult patients managed for HE at FMC, Umuahia, were recruited. Data obtained included a total number of medical and diabetic admissions within the study period. For participants that met the inclusion criteria for the study, their bio­data, blood pressures, level of consciousness at presentation or while being treated, random plasma glucose, plasma electrolytes, urea, creatinine, and plasma 3­beta­hydroxybutyrate were noted and/or measured. Similarly, urine sample was collected from each participant for analysis (glucose, protein, and ketone). The outcome measures were patient's survival, hospitalization duration, and death. Analysis of data was done using SPSS 20.0 and the level of statistical significance was set at P < 0.05. Results: Of the 110 participants recruited, there were 46 (41.8%) males and 64 (58.2%) females. HE constituted 15.6% of the total medical admissions within the study period with a mortality of 10%. DKA and mixed form of HE were the predominant patterns in the study. While hospitalization duration was variable, no female participant was discharged against medical advice. Conclusion: The study showed that HE is a frequent acute complication of DM in this region ofNigeria and that HE typically presents as DKA and mixed form. Hospitalization for HE had a variable duration with a significant mortality

Pattern and outcome of Diabetic Ketoacidosis among children with Type 1 Diabetes mellitus at Ile-Ife, Nigeria

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of Diabetes mellitus. There are few reports on the pattern and outcome of DKA in childhood diabetes in Nigeria but none on the diabetic population from Osun State, Nigeria. Objective: To determine the pattern and factors influencing the outcome of children managed for DKA at the Paediatric Endocrinology Unit of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, over a ten-year period. Methods: A retrospective review of the clinical records of all the children managed for Type-1 Diabetes mellitus (TIDM) over ten years (2007-2016) was done. Relevant information was obtained from the clinical records and the data were analyzed. Results: A total of 15 children with DKA comprising 8 (53.3%) males and 7 (46.7%) females were studied. The male to female ratio was 1.1:1. Twenty-eight episodes of DKA were recorded during the period, thus putting the average frequency per patient at 1.9. DKA was the first manifestation of DM in the majority (86.7%) of the subjects. The mean age at diagnosis of DM was 11.9+3.6 years with about half (53.3%) occurring during pre-adolescence. The socioeconomic status of the affected families had an inverse relationship with the frequency of DKA. Conclusion: DKA is the most common initial presentation of Type-1 DM among Nigerian children, with a high rate of recurrence and an inverse relationship with socioeconomic status

Profils épidémiologiques des acidocétoses diabètiques aux urgences

Introduction: l'acidocétose diabétique (ACD) est une complication métabolique grave du diabète. Son incidence est en augmentation ces dernières années, cependant sa mortalité reste faible. L'objectif de cette étude a été de décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques des patients admis aux urgences pour ACD sévère ou modérée. Méthodes: il s'agissait d'une étude prospective, descriptive qui a inclus les ACD modérée ou sévère. Standardisation du protocole de prise en charge thérapeutique. Nous avons étudié les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques chez ces patients. Résultats: nous avons inclus 185 patients avec ACD sévère ou modérée. L'âge moyen a été de 38±18 ans; le sexe ratio=0,94. Diabète connue= 159 patients (85%) dont 116 étaient des diabétiques type 1. Les facteurs de décompensation les plus fréquents étaient l'arrêt du traitement chez 42% et l'infection chez 32%. La glycémie moyenne a été de 32,7±12mmol/L, pH =7,14±0,13, HCO-3 =7,2±3,56 mmol /L. La durée moyenne de l'insuline intraveineuse était de 17,3±16 heures. L'hypoglycémie a été observée chez 26 patients (14%), l'hypokaliémie chez 80 (43%). La mortalité au cours de l'hospitalisation a été de 2,1%. Conclusion: l'acidocétose diabétique survient chez les sujets jeunes traités par insulinothérapie. Le traitement est à base d'insuline par voie intraveineuse en plus de la correction du déficit hydrique. Les complications sont essentiellement l'hypokaliémie et l'hypoglycémie; et la mortalité reste faible

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

Background: Diabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal. Methods: A retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period. Data included patients' demographic profile, clinical presentation, precipitating factors, comorbidities, biochemical profile, length of hospital stay and outcome.Results: One hundred and five black South African patients above the age of 12 years were included in the study. Sixty-four (60.95%) patients had type 1 diabetes mellitus (T1DM) and 41 (39.05%) patients had type 2 diabetes mellitus (T2DM). Patients with T2DM were significantly older than those with T1DM (52.1 ± 12.4 years vs. 24.4 ± 9.5 years, p < 0.0001). The acute precipitant was identified in 68 (64.76%) cases with the commonest precipitant in T1DM patients being poor adherence to treatment, whereas in T2DM, the most common precipitant was infection. Nausea and vomiting were the most common presenting symptoms with the majority of patients presenting with non-specific symptoms. Fifty-seven (54.29%) cases had pre-existing comorbidities, with higher prevalence in T2DM than T1DM patients. Glycated haemoglobin was severely elevated in the majority of patients. Patients remained hospitalised for an average of 8.9 ± 7.5 days. The mortality rate was 17.14%, and 12 of the 18 deaths occurred in patients with T2DM.Conclusion: The prevalence of DKA was higher in patients with T1DM and those with pre-existing comorbidities. The mortality rate remains alarmingly high in older patients with T2DM

Clinical profile and outcome of hyperglycaemic emergencies at a rural hospital in southern Nigeria

We have documented the clinical pattern of hyperglycaemic emergencies (HGEs) and predictors of outcome at a tertiary hospital in a rural setting in Nigeria. In a 2-year retrospective review, we identified 88 patients with HGEs. Fifty-four (61%) were females, and mean age was 55 years. Forty-seven (53%) had hyperglycaemic hyperosmolar states (HHS), 34 (39%) had diabetic ketoacidosis (DKA), and 7 (8%) had a mixed type of HGE. The commonest precipitating factor was infection and was seen in 39 (44.3%) patients; 28 (32%) were newly diagnosed with diabetes. The mortality rate overall was 34% and the case fatality rate of DKA, HHS, and mixed-type HGE was 23%, 38%, and 57% respectively. Elevated urea was a predictor of poor outcome; while age, gender, and the presence of chronic diabetes complications were not predictors of outcome. We conclude that the mortality rate in HGEs is high, and that elevated urea is a predictor of poor outcome.Effective diabetes education, prompt recognition of symptoms, and treatment of metabolic derangements in HGEs may reduce morbidity and mortality

Complications aigues métaboliques du diabète sucré dans le Service de Réanimation Polyvalente du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou au Burkina Faso

Objectif : Etudier les complications aiguës métaboliques (CAM) du diabète sucré dans le Service de Réanimation Polyvalente (SRP) du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) au Burkina Faso.Patients et méthodes : Etude rétrospective sur une période de cinq ans (1erjanvier 2008 au 31 décembre 2012). La population d'étude était constituée des patients admis dans ledit service pour une CAM du diabète sucré. Résultats :Soixante-six patients ont été retenus pour l'étude.La fréquence d'admission pour des CAM de diabète était de 6,5% avec un âge moyen de 55 ± 17 ans et une prédominance masculine (sex-ratio=1 ,06). Les principaux motifs d'admission étaient lecoma grave (62,1%), détresse respiratoire (81,8%) et déshydratation (15,1%).La mauvaise observance thérapeutique était retrouvée dans 64,5%.L'acidocétose constituait 59,1% des CAM suivie de l'hypoglycémie (27,3%) et du syndrome d'hyperglycémie hyperosmolaire(SHH) (13,6%). L'hyperglycémie moyenne était de 26, 31 mmol/L et l'hypoglycémie moyenne de 1,3 ± 0,7 mmol/L. Une cétonurie (69,1%) et une glycosurie (67,8%) étaient observées. Les complications étaient associées à un âge avancé (p= 0.003).L'infection constituait le principal facteur de décompensation. La durée moyenne de séjour était 5,8 ± 5,6 jours.La mortalité globale (54,55%) était liée à la gravité du coma (p=0,007).Conclusion : Les CAM du diabète sucré sont relativement fréquentes dans le SRP du CHU-YO à Ouagadougou. Le taux de mortalité est élevé. Une prise en charge précoce et adaptée pourrait améliorer le pronostic vital

Profil epidemiologique et clinique du diabete de type 1 chez l'enfant en milieu hospitalier dakarois

Introduction: Le diabete de type 1 (DT1) est l'une des endocrinopathies les plus frequentes chez l'enfant. L'objectif de cette etude etait de decrire les aspects epidemiologiques; cliniques et evolutifs du DT1 au Centre Hospitalier National d'Enfants Albert Royer.Patients et methodes: Il s'agissait d'une etude retrospective descriptive incluant tous les enfants ages de 0 a 15 ans hospitalises dans le service pour DT1 de 2007 a 2013. Nous avons analyse les donnees socio-demographiques; cliniques et evolutives. Resultats: Cent dix neuf (119) enfants etaient admis durant cette periode; representant une prevalence hospitaliere de 3;6 %. L'age moyen etait de 7;8 ans et le sex ratio 1;2 en faveur des garcons. L'origine etait suburbaine dans 65;9%. Le niveau socio-economique et le niveau d'education des parents etaient juges bas dans 65;9% et 63;6% respectivement. Un antecedent familial de diabete etait retrouve pour 77;3% des patients. L'acidocetose etait la circonstance de decouverte la plus frequente (86% des cas). La letalite hospitaliere etait de 6;7%. Seuls 24 patients (20;16 %) etaient regulierement suivis dans le service et 49 (41;17%) patients avaient interrompu leur suivi. Conclusion: L'augmentation croissante de la prevalence est une preoccupation de sante publique avec une implication socio-economique. Des efforts doivent etre faits pour un diagnostic precoce et un suivi de qualite. Ceci passe par la formation et le renforcement des capacites des prestataires de sante au niveau peripherique et une meilleure collaboration des differents services de prise en charge du diabete de l'enfant

Diabetic Ketoacidosis Presenting with Fournier's Gangrene

A case of survival of a patient with Fournier's gangrene and diabetic ketoacidosis is described. Careless handling of itchy scrotal disease in this diabetic patient was responsible for the onset of scrotal gangrene. Early recognition of diabetic ketoacidosis and Fournier's gangrene and prompt treatment led to survival. Consequently; early consultation of a physician/dermatologist is advised when diabetics have itchy groin lesions; while doctors are urged to routinely examine the scrotum of patients with diabetic ketoacidosis