Journal of Diabetology

ORIGINAL ARTICLES
Year
: 2021  |  Volume : 12  |  Issue : 2  |  Page : 151--156

Assessment of acute complications of diabetes mellitus using clinical records of diabetic patients in Adama Hospital Medical College, Oromia Regional State, Ethiopia


Tigist Tilaye1, Bayissa Chala2,  
1 Olanchiti Hospital, Oromia Regional State Health Bureau, Oromia Regional State, Adama, Ethiopia
2 Department of Applied Biology, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia

Correspondence Address:
Dr. Bayissa Chala
Department of Applied Biology, School of Applied Natural Science, Adama Science and Technology University, P.O. Box 1888, Adama.
Ethiopia

Abstract

Background: Diabetes mellitus (DM) is one of the emerging public health problems in developing countries. Patients with acute complications of the disease frequently seek care in hospital emergency departments. However, the magnitude of acute complications of DM has not been studied at facility levels. This study was aimed at assessing the prevalence and associated risks of acute complications of DM at health facilities. Materials and Methods: Hospital-based cross-sectional study design was used. The source of population was medical records of DM patients and the study population was medical records of DM patients admitted to Adama Hospital Medical College. A total of 200 medical records of patients in AHMC medical ward were used to extract patients’ medical information concerning DM and associated factors. Moreover, DM-related pretested semi-structured questionnaires were developed and administered to 200 active DM patients following their treatment during December 2018 of data collection. Results: The proportion of diagnosed acute complications of DM among patients in this study was 146(73%) while 54(27%) did not present acute complication of DM. The history of acute complication associated with diabetic ketoacidosis (DKA) accounted for 133(66.5%) while hyperglycemic hyperosmolar state (HHS) was 21(10.5%) but 46(23%) did show neither DKA nor HHS. From this study of clinical record, the proportion of acute complication of DM with DKA was higher among type I DM patients than type II patients. However, the proportion of HHS was relatively low in type I DM and high in type II DM patients. Conclusion: The prevalence of acute complications of DM was 146(73%) and 67(85.9%) and 79(64.8%) in type I and type II DM, respectively. Moreover, the proportion of acute complication of DM with DKA was higher among type I DM patients than type II patients. Strengthening of health education both at health facilities and general population is important.



How to cite this article:
Tilaye T, Chala B. Assessment of acute complications of diabetes mellitus using clinical records of diabetic patients in Adama Hospital Medical College, Oromia Regional State, Ethiopia.J Diabetol 2021;12:151-156


How to cite this URL:
Tilaye T, Chala B. Assessment of acute complications of diabetes mellitus using clinical records of diabetic patients in Adama Hospital Medical College, Oromia Regional State, Ethiopia. J Diabetol [serial online] 2021 [cited 2021 May 16 ];12:151-156
Available from: https://www.journalofdiabetology.org/text.asp?2021/12/2/151/312658


Full Text



 Introduction



Diabetes is one of the oldest noncommunicable diseases of mankind affecting both the young and old age groups. In 1889 it has been reported that depancreatized dogs developed diabetes.[1] It was then logical to assume that diabetes was simply a hormone deficiency syndrome. Studies showed that the global burden of diabetes has increased 12-fold between 1985 and 2011.[2],[3] The International Diabetes Federation (IDF) suggests that the number of adults living with diabetes worldwide will further expand by 50.7% by 2030.[2]

The acute complications of diabetes which may take the form of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) are the leading causes of admission worldwide.[3] Studies have reported that diabetes and its complications are among the common reasons for inpatient admissions, accounting for about 4.4% of total admissions leading to about 3.4% total deaths.[4],[5],[6] The outcomes of diabetic complications have increased not only hospitalization but also direct patient costs, and mortality. It has been reported that prevalence of diabetes is higher in developed than in developing countries; however, the past two decades diabetes mellitus (DM) was reported to be higher in developing countries.[7] The world prevalence of diabetes among adults aged 20–79 years was estimated 6.4% in 2010 and will increase to 7.7% by 2030.[8]

According to the 2011 report of IDF, the number of adults living with diabetes in Ethiopia was 3.5%.[2] which has increased to 4.84% in 2014.[9] In particular, a prevalence range of 3.3% to 6.5% of DM was reported in Southern Ethiopia,[10] 1.3% in Northern part of Ethiopia,[11] and 3.64% in Northwestern of the country.[12] Similar reports from urban Commercial Bank employees in Ethiopia showed a 6.5% prevalence of DM which indicated the significance of lifestyle for DM etiology.[13]

DM has a lot of complications and comorbidities which may increase the cost of management, morbidity, and mortality associated with the disease. In Ethiopia, there appears limited reports concerning acute complications of DM. A study report from Jimma town, southwestern Ethiopia, showed that acute complications of DM were observed more commonly among type I diabetics than type II and DKA was the commonest acute complication.[14] It has been reported that the prevalence of DM is considerably high among the urban compared to the rural population. Moreover, reports also showed that population-based estimations of the disease are either lacking or largely undiagnosed and untreated, especially in rural settings.[12]

So far, most of the DM studies in Ethiopia focused on community-based health facilities. Facility-based epidemiological information is essential to understand the whole picture of DM in Ethiopia to help expand service availability and appropriate clinical intervention.[13],[14],[15],[16] Likewise, studies recommend that assessing and comparing the prevalence of acute complications of DM in hospitals is crucial to take appropriate measures by the governmental and clinical decision-makers.[17] Although a whole array of effective interventions to prevent diabetes and its complications is available, research data are limited in Adama Hospital Medical College. Therefore, this study was designed to assess the prevalence of acute complications and associated factors of DM patients using clinical records in Adama Hospital Medical College.

 Materials and Methods



Description of the study area

A cross-sectional study was conducted in December 2018, in Adama Hospital Medical College, located in Adama town, east-central Ethiopia, 100km from Addis Ababa. The town is comparatively urban having 3 hospitals (one public, and two private, and 8 health centers (7 public and 1 NGO) to serve a population of over 4 million as of 2007 census.[18] As the only public healthcare facility, Adama Hospital Medical College was established in 1954 supposed to provide health services to outpatient and inpatient departments. Currently, it has a total of 200 beds of which 39 are in the medical ward. There were about 1950 diabetic patients who have been following the outpatient department of diabetic admission center since 2000.

Study design and sampling techniques

Hospital-based cross-sectional study design was used. The source of population was medical records of DM patients and the study population was medical records of DM patients of admitted to Adama Hospital Medical College. The sample size was determined with the assumptions of an expected prevalence of complication 50%, margin of error 7%, at 95% confidence level with corrections for finite population which gave a sample size of 196. A total of 200 samples were enrolled in this study. Using systematic sampling, every tenth card was selected starting from the lowest card number in ascending order. When the tenth card was missing, the next card was used. Data were extracted using designed forms including socio-demographic and background information. The form used to collect data was on type of DM, duration of illness, type of drug, type of acute complication, and other complications.

In addition, DM-related pretested semi-structured questionnaires were developed and administered to 200 active DM patients following their treatment during December 2018 of data collection. Dependent variable was acute complications of DM while independent variables were age, sex, type of DM and drug used, duration of illness and other complications.

Data analysis

Data were analyzed using MS-Excel and Statistical Package for Social Sciences (SPSS) software, version 20. Patients’ sociodemographic characteristics and diabetes-specific variables were summarized using frequency distribution tables. Data were described using means for continuous variables (sex, age, other complications, duration of illness, other illnesses) and proportions for categorical variables (risk factors, and type of treatment). Associations between variables were tested by the use of the chi-square test. All factors with a value of P = 0.05 were considered statistically significant.

Ethical consideration

The study was carried out after obtaining ethical clearance from Adama Hospital Medical College ethical review committee. After a thorough review of the proposal the committee wrote an approval letter to concerned AHMC officials for smooth running of data collection. The information gathered from records was treated confidentially and norm of the hospital was considered and respected in the process of data collection.

Operational definitions

Cardiac disease: refers to group of disorders of heart and blood vessels including coronary artery disease.

Diabetic ketoacidosis: a potentially life-threatening complication of DM characterized by absolute insulin deficiency.

DM: a chronic disease associated with abnormally high levels of the sugar glucose in the blood.

Hypertension: a serious medical condition in which the blood vessels have persistently raised pressure high or raised blood pressure.

Kidney diseases: also called renal disease characterized by damage of the kidney that reduces interferes with its function.

 Results



Acute complication of diabetes mellitus

Acute complication of DM from the clinical record was associated with different parameters. The diagnosed acute complications of DM were presented by 146(73%), while the rest 54(27%) did not but the difference did not reach statistical significance (P = 0.137) [Table 1]. When history of acute complication was observed, DKA accounted for 126(94.7%) while the number of patients without DKA was 7(5.7%). Likewise among the admitted patients 17(81%) and 4(19%) were with HHS and without HHS, respectively. The association showed a strong statistical significance (P = 0.000). On the contrary, there was no admitted inpatient case with hypoglycemia. In the same manner, the association between acute complication and type of DM also showed strong statistical significance (P = 0.001) [Table 1].{Table 1}

Concerning the age categories obtained from the clinical record, the age group of 18–30 years and 31–40 years over showed strong statistical significance accounting for 96.9% and 82.9% of acute complications, respectively. The least was the age group above 40 years with 54% of acute complication [Table 1]. The age of patients ranged from 18 to 86 years with a mean of 44 years.

Concerning acute complication of DM patients versus the duration of illness, new admission accounted for 87.1% followed by 78.3% with less than 5 years of illness with statistical significance of P = 0.000 and 0.003, respectively. Among other complications, only kidney injury showed statistical significance (P = 0.000) but the rest complications did not [Table 1]. Similarly, acute complication and type of drug used showed a strong statistical association with a value of P = 0.001 [Table 1].

Factors associated with acute complication of diabetes mellitus

The major factors associated with acute complication of DM in this study were identified as pneumonia, urinary tract infection, cellulites, acute gastroenteritis, poor glycemic control, and drug discontinuation. Of all, poor glycemic control was found the highest risk factors 15(100%) followed by pneumonia (95.5%). All the risk factors except drug discontinuation showed strong statistical significance [Table 2].{Table 2}

Sociodemographic characteristics

A total of 200 DM outpatients under follow-up in Adama Hospital Medical College were included for interview and pretested questionnaire prepared to supplement the clinical data. From the administered questionnaire, the proportion of socio-demographic data of respondents of DM outpatients was 113(56.5%) males and 89(43.5%) females with the mean age of 47 years. The data also showed that DKA in males was higher than in females.

Comparison of acute DM complication among Type I and II DM outpatient respondents under follow-up in Adama Hospital Medical College showed that DKA among type I DM patients slightly outnumbered 136(68%) that of HHS 122(61%), the other prominent hallmark of acute complication of DM.

The overall proportion of DKA showed a sharp decrease from new admission DM patients to age group <5 years followed by 5–15 years and above 15 years, respectively. On the contrary, HHS did not show a significant difference among respondents of age group. The comparison of acute DM complication with age distribution of respondents was summarized in [Figure 1].{Figure 1}

 Discussion



The world prevalence of diabetes among adults of age 20–79 years was estimated to be 6.4% in 2010 and will increase to 7.7% by 2030.[8] Studies have also reported that diabetes and its complications are among the common reasons for inpatient admissions, accounting for about 4.4% of total admissions leading to about 3.4% to 32.5% total deaths.[4],[5],[6]

From the clinical record of this study, 122(61%) were admitted by type II DM and 78(39%) were with type I DM. This result is in consistent with earlier reports in Ethiopia [Figure 2].[14],[19] The main finding from the extracted medical records showed that the prevalence of acute complications of DM was 146(73%) and 67(85.9%) and 79(64.8%) in type I and type II DM, respectively. The result of this study on acute complication showed higher proportion in type I DM in both male and female groups than type II DM patients. The finding of this study was in agreement with study report from Jimma town, southwestern Ethiopia, showed that acute complications of DM were observed more commonly among type I diabetics than type II and DKA was the commonest acute complication.[14] It has also been reported that Type 1 diabetic patients are more prone to develop DKA and DKA is more associated with Type 1 DM than Type 2.[20]{Figure 2}

The average proportions of acute DM complication with DKA and HHS from the medical records were 126(94.7%) and 17(81%), respectively, but no hypoglycemia was observed from the medical records. It is an established data that HHS is commonly diagnosed among elderly individual with type II DM patients than with type I. Previous studies reported that the outcomes of DM complications have increased not only hospitalization but also direct patient costs, and mortality. More importantly, acute complications of diabetes are the leading causes of admission worldwide.[3]

In Ethiopia, there appear limited reports concerning acute complication of DM though the issue is serious problem of the community. In our questionnaire survey, the data of acute complication was cross-tagged with multiple associated factors like the duration of illness and age categories. The data showed that DM complications were more common among newly admitted patients 61(87.1%) and followed by 47(78.3%) of patients with less than 5 years of duration of illness. The higher proportion of new admission of less than 5 years of illness of DM patients with acute complications shows that most DM patients are commonly admitted by acute complications.

The major factors associated with acute complication of DM in this study were identified as pneumonia, urinary tract infection, cellulites, acute gastroenteritis, poor glycemic control and drug discontinuation. Of all, poor glycemic control was found the highest risk factors15 (100%) followed by pneumonia (95.5%). All the risk factors except drug discontinuation showed strong statistical significance (P = 0.000) [Table 2].

The data obtained from questionnaire survey revealed that DKA among type I DM patients 136(68%) was slightly higher than HHS 122(61%) which agrees with the data from medical record of this study and previous study reports.[14],[21] From the survey, relatively more males were associated with DKA compared to females. In addition, the overall proportion of DKA showed a sharp decrease from new admission of DM patients compared to the age group <5 years, 5–15 years and above 15 years [Figure 1].

 Conclusion and Recommendations



From this study of clinical record, the prevalence of acute complications of DM was 146(73%) and 67(85.9%) and 79(64.8%) in type I and type II DM, respectively. Moreover, the proportion of acute complication of DM with DKA was higher among type I DM patients than type II patients. However, the proportion of HHS was relatively low in type I DM and high in type II DM patients.

As a recommendation, strengthening of health education both at different levels in the health facilities and general population is important as part of strategies to prevent, manage, and control the disease. Low-cost approaches of obtaining data from community and health facilities in a standardized manner are worth considering. It is obvious that population-based epidemiological information from both urban and rural populations is essential to understand the whole picture of DM in Ethiopia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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