Tiruneh Kasie Gebeyehu, Mekonnen Migbar Sibhat, Getnet Zemeskel Addisu, Ayehu Akele Mequanint, Meno Abose Abinet, Zewde Wendimu Ashenafi
Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
Department of Nursing, College of Medicine and Health Sciences, Dilla University, 419 Dilla, Ethiopia.
Ther Adv Endocrinol Metab. 2024 Dec 11;15:20420188241303416. doi: 10.1177/20420188241303416. eCollection 2024.
Hyperglycemic emergencies (HGEs) are the major deadliest acute complications of diabetes. HGEs have reached an alarming stage and increased year-to-year leading to increased morbidity, hospitalization, and mortality. Despite HGEs causing this increased healthcare, psychological, social, and economic burden, studies conducted to address this burden and its predictive factors remain limited. Thus, this study aimed to investigate the incidence and predictors of HGEs among adult diabetic patients.
An institution-based retrospective follow-up study was employed on 538 systematically selected adult diabetic patients who had diabetic follow-up in Sidama region and Gedeo zone public hospitals from September 1, 2018, to September 1, 2022. The sample size was determined using STATA V-14. Data were collected using an extraction checklist, entered into EPI data version 4.4.2.2, and analyzed using STATA version 14. The Kaplan-Meier curve and log-rank test were used to determine the survival probabilities and to compare the survival status. The Cox proportional hazard regression model was used to determine the association and identify the predictor variables. A statistical significance was declared at a -value of <0.05 in line with a 95% confidence interval (CI) and hazard ratios.
The study was conducted on 538 diabetic adult patients with a response rate of 100%. The mean age of study participants was 44.5 years, and more than 66.7% were males. The incidence rate of HGEs was found to be 29 (95% CI: 25.3-33.2) per 1000 person-months with a total of 7176.5 person-month observations. Being farmer (adjusted hazard ratio (AHR) = 6.47; 95% CI: 2.61-16.04), poor glycemic control (AHR = 6.84; 95% CI: 3.47-13.49), less frequent diabetic follow-up (AHR = 4.00; 95% CI: 1.02-15.57), and having hypertension (HTN) (AHR = 2.94; 95% CI: 1.62-5.34) were significantly associated with increased hazard of acquiring HGEs among adult diabetic patients. Conversely, the hazard of experiencing HGE was 63% lower among patients who had diabetic nephropathy relative to those without diabetic nephropathy (AHR = 0.35; 95% CI: 0.15-0.83). Hence, setting and strengthening specific diabetic management strategies focused on the identified predictors could be paramount to reducing HGEs and their unwanted effects. Moreover, it's better to consider more frequent diabetic follow-up visits for all patients regardless of other complications.
高血糖急症（HGEs）是糖尿病最致命的主要急性并发症。HGEs已达到令人担忧的阶段，且逐年增加，导致发病率、住院率和死亡率上升。尽管HGEs造成了这种日益增加的医疗、心理、社会和经济负担，但为解决这一负担及其预测因素而开展的研究仍然有限。因此，本研究旨在调查成年糖尿病患者中HGEs的发病率及预测因素。
采用基于机构的回顾性随访研究，对2018年9月1日至2022年9月1日期间在锡达马地区和格德奥地区公立医院进行糖尿病随访的538名系统选取的成年糖尿病患者进行研究。样本量使用STATA V - 14确定。数据通过提取清单收集，录入EPI数据版本4.4.2.2，并使用STATA版本14进行分析。采用Kaplan - Meier曲线和对数秩检验来确定生存概率并比较生存状态。使用Cox比例风险回归模型来确定关联并识别预测变量。根据95%置信区间（CI）和风险比，当P值<0.05时声明具有统计学意义。
该研究对538名成年糖尿病患者进行，应答率为100%。研究参与者的平均年龄为44.5岁，超过66.7%为男性。HGEs的发病率为每1000人 - 月29例（95% CI：25.3 - 33.2），总观察人 - 月数为7176.5。职业为农民（调整后风险比（AHR）= 6.47；95% CI：2.61 - 16.04）、血糖控制不佳（AHR = 6.84；95% CI：3.47 - 13.49）、糖尿病随访频率较低（AHR = 4.00；95% CI：1.02 - 15.57）以及患有高血压（HTN）（AHR = 2.94；95% CI：1.62 - 5.34）与成年糖尿病患者发生HGEs的风险增加显著相关。相反，患有糖尿病肾病的患者发生HGEs的风险比未患糖尿病肾病的患者低63%（AHR = 0.35；95% CI：0.15 - 0.83）。因此，制定并加强针对已确定预测因素的特定糖尿病管理策略对于减少HGEs及其不良影响至关重要。此外，无论有无其他并发症，最好考虑对所有患者增加糖尿病随访次数。
