Adem Amir, Demis Tilahun, Feleke Yeweyenhareg
Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University.
Ethiop Med J. 2011 Jul;49(3):231-8.
The prevalence of diabetes has been shown to increase especially in developing countries, over the last decades.
We investigated the trend of diabetic admissions, indications, chronic complications, comorbidities and outcomes in Ethiopian diabetic patients.
A retrospective study was conducted in all diabetic admissions at the Department of Internal Medicine of Tikur Anbessa and St. Paul's Specialized University teaching hospitals from January 2005-December 2009. Data were collected from medical records, diabetic clinic registries, admissions, discharges and death certificates using structured questionnaires.
Total of 724 admissions, 51.7% males and 48.3%females were analyzed Among them 375 (51.8%) patients were Type-1 diabetes, 345 (47.6%) were Type 2 diabetes and the rest three were associated with Hyperthyroidism, and one with Cushing's syndrome. The median and mean age was 27.5 years, 30.1 +/- 12.6 years and 56.00 years, 55.1 +/- 14.5 yrs (p < 0.001) for Types 1 and 2 Diabetes respectively. The median and mean duration of diabetes for Type 1 before admission was 6.00, 8.7 +/- 7.6 and for Type 2 was 10.00, 11.3 +/- 7.5.years (p < 0.001). The admission rate increased serially from 51 (7.1%) patients in year 2005 to 86 (12.0%) in 2006, 144 (20.0%) in 2007, 193 (26.8%) in 2008 and 245 (34.1%) in 2009. There was no statistical significance difference between the types of diabetes (P = 0. 73, X2 = 2.0). Eleven percent and 3.6% were admitted twice and three times respectively. Commonest cause for admission was Diabetic Ketoacidosis (DKA) (71.1%), followed by who had infections (36.3%). Among those with infection, pneumonia occurred in 67 (9.9%), UTI occurred in 55 (8.1%), diabetic foot ulcer in 70 (9.7%), tuberculosis in 42 (5.5%) other infections in 10 (1.4%) of patients. Cardiovascular diseases (CVD) occurred in 126 (18.4%) and Hypertension was found in 250 (34%), hypoglycemia in 1.2% diabetic patients. Diabetic nephropathy, retinopathy, and neuropathy accounted 32% 15.5% and 12.4% respectively. Of total deaths (10.6%), CVD accounted for 28% infections for 14.8% and DKA for 5.8% In each year of the studied period, DKA persisted to be the leading cause for admission followed by infections.
This study showed the serial increment of diabetic admissions over the study period Commonest causes for admission were DKA followed by infection and cardiovascular diseases. Mainly Cardiovascular diseases were the leading causes of death in hospitalized diabetic patients. So we recommend the. health policy makers to be alarmed of the growing magnitude of Diabetes Mellitus and strengthen methods of prevention and control of Diabetes Mellitus and associated cardiovascular diseases.
在过去几十年中，糖尿病的患病率已呈现出上升趋势，尤其在发展中国家更为明显。
我们调查了埃塞俄比亚糖尿病患者的糖尿病入院趋势、指征、慢性并发症、合并症及预后情况。
对2005年1月至2009年12月期间提库尔·安贝萨和圣保罗专科医院内科所有糖尿病住院患者进行回顾性研究。使用结构化问卷从病历、糖尿病门诊登记册、入院记录、出院记录及死亡证明中收集数据。
共分析了724例住院患者，其中男性占51.7%，女性占48.3%。其中375例（51.8%）患者为1型糖尿病，345例（47.6%）为2型糖尿病，其余3例与甲状腺功能亢进有关，1例与库欣综合征有关。1型和2型糖尿病患者的年龄中位数分别为27.5岁、30.1±12.6岁以及56.00岁、55.1±14.5岁（p<0.001）。1型糖尿病患者入院前糖尿病的病程中位数和均值分别为6.00、8.7±7.6年，2型糖尿病患者分别为10.00、11.3±7.5年（p<0.001）。入院率逐年上升，从2005年的51例（7.1%）增至2006年的86例（12.0%）、2007年的144例（20.0%）、2008年的193例（26.8%）以及2009年的245例（34.1%）。糖尿病类型之间无统计学显著差异（P = 0.73，X2 = 2.0）。分别有11%和3.6%的患者入院两次和三次。最常见的入院原因是糖尿病酮症酸中毒（DKA）（71.1%），其次是感染（36.3%）。在感染患者中，肺炎发生在67例（9.9%），尿路感染发生在55例（8.1%），糖尿病足溃疡发生在70例（9.7%），结核病发生在42例（5.5%），其他感染发生在10例（1.4%）患者中。心血管疾病（CVD）发生在126例（18.4%），高血压发生在250例（34%），低血糖发生在1.2%的糖尿病患者中。糖尿病肾病、视网膜病变和神经病变分别占32%、15.5%和12.4%。在总死亡病例（10.6%）中，CVD占28%，感染占14.8%，DKA占5.8%。在研究期间的每年，DKA一直是主要的入院原因，其次是感染。
本研究表明在研究期间糖尿病入院病例呈逐年增加趋势。最常见的入院原因是DKA，其次是感染和心血管疾病。主要是心血管疾病是住院糖尿病患者的主要死亡原因。因此，我们建议卫生政策制定者警惕糖尿病规模的不断扩大，并加强糖尿病及相关心血管疾病的预防和控制方法。
