INCIDENCE AND PREDICTORS OF HYPERGLYCEMIC EMERGENCIES AMONG ADULT DIABETES MELLITUS PATIENTS AT PUBLIC HOSPITALS OF HARARI REGION, EASTERN ETHIOPIA: A FACILITY- BASED RETROSPECTIVE COHORT STUDY

Abstract

Hyperglycemic emergencies are the most common life threatening acute metabolic complications of diabetes mellitus. The number of Hyperglycemic emergency admissions over the past decade has increased worldwide, with recent data reporting a 55% rise in the rate of diabetic ketoacidosis hospitalizations. However, data on the incidence of hyperglycemic emergencies are very limited in low- and middle-income countries, particularly in Ethiopia. Objective: This study aimed at identifying the incidence and predictors of hyperglycemic emergencies among adult Diabetes Mellitus patients at the public hospitals of Harari region. Methods: A retrospective cohort study design was conducted among 496 adults with Diabetes Mellitus. All diabetic patients on chronic follow-up between July 01, 2019 to June 30, 2024 were included in the study. The data were extracted from July 1 to 31, 2024, by reviewing patients’ medical records. Patients’ charts were selected randomly using excel generated random numbers. Data were collected by Kobo toolbox and analyzed using STATA software version 17. Kaplan Meier curve and log-rank test were done to estimate the survival probability and to statistically test survival between different categories, respectively. A Cox proportional hazard regression model was used to identify the predictors. Variables with a P-value < 0.25 in the bi-variable analysis were candidate for multivariable Cox proportional hazard model. Hazard ratios (HR) with its respective 95% confidence interval (CI) were reported. Statistical significance was declared at P-values <0.05. Results: Of the 472 patients, 34.11% (95% CI:29.96%-38.52%) developed hyperglycemic emergencies. The incidence rate of hyperglycemic emergencies was 18.6 per 100 person-years observation (95%CI: 15.9-21.7). The overall median hyperglycemic emergency-free survival time was 51.06 months (95% CI: 45.14-58.56). Being rural area residents (Adjusted Hazard Ratio(AHR): 1.52, 95% CI: 1.07,2.16), not having community health insurance (AHR: 1.63, 95% CI: 1.14-2.34), experiencing acute recent illness (AHR: 2.15, 95% CI: 1.51,3.07), having type one diabetes mellitus (AHR: 1.97, 95% CI: 1.23,3.15), having poorly controlled blood glucose (AHR: 3.06, 95% CI: 2.01,4.66), non-compliance of diabetes medication (AHR: 2.25, 95% CI: 1.55,3.26), being obese (AHR: 3.75, 95% CI: 1.84,7.64) and overweight (AHR: 2.56, 95% CI: 1.72,3.81) were factors significantly associated with hyperglycemic emergencies. xi Conclusion: The findings demonstrated that the incidence of hyperglycemic emergencies was high. Rural residence, without community health insurance, acute recent illness, type one diabetes mellitus, poor glycemic control, history of medication noncompliance, overweight and obesity increased the hazards of developing hyperglycemic emergencies. Hence, special emphasis should be given to follow-up care for diabetic patients with identified predictors to reduce the occurrence of these emergencies