The burden of diabetic emergencies on the resuscitation area of a district-level public hospital in Cape Town
Thesis (MFamMed)--Stellenbosch University, 2020.
ENGLISH SUMMARY : Introduction: Diabetes and its complications continue to cause a daunting and growing concern on resource-limited environments. There is a paucity of data relating to the care of diabetic emergencies in the emergency centres of entry-level hospitals in Africa. The aim of this study was to describe the burden of diabetic emergencies presenting to the emergency centre of an urban district-level hospital in Cape Town, South Africa. Methods: The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for patients presenting with a diabetic emergency within a 24-week randomly selected period. The database was supplemented by a retrospective chart review to include additional variables for participants with diabetic ketoacidosis (DKA), uncomplicated hyperglycemia, severe hypoglycaemia and hyperosmolar hyperglycaemic state (HHS). Summary statistics are presented of all variables. Results: The prevalence of all diabetic emergencies was 8.1% (197/2424) (DKA n=96, 48.7%; uncomplicated hyperglycaemia n=45, 22.8%; severe hypoglycaemia n=44, 22.3%; HHS n=12, 6%). The median age was 48 years, with those presenting with DKA being substantially younger (36 years). A likely precipitant was identified in 175 (88%) patients; infection was the most common precipitant (n=79, 40.1%). Acute kidney injury occurred in 80 (40.6%) cases. The median length of stay in the resuscitation area was 13 hours (IQR 7.2-24) and 101 (51.3%) participants represented with a diabetic- related emergency within six months of the study period. The overall mortality rate was 5% (n=10). Conclusion: This study highlights the high burden of diabetic emergencies on the provision of acute care at a district- level hospital. The high prevalence of diabetic emergency presentations (8%), the high infection rate (40%), and the high percentage of patients returning with a diabetic emergency (51%) could be indicative of the need for improved community-based diabetic programmes.
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