Jurnal internasional Afrika vol.11 issue 4 2021
African Journal of Emergency Medicine
The burden of diabetic emergencies on the resuscitation area of a district-level public hospital in Cape Town

Jurnal internasional Afrika vol.11 issue 4 2021
African Journal of Emergency Medicine
The burden of diabetic emergencies on the resuscitation area of a district-level public hospital in Cape Town

Diabetes
Emergency
South Africa
Diabetic ketoacidosis
Burden

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 pre-
senting 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 hyperglycaemia, 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 h (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 emergencies (8%) consisted of DKA (48.7%), uncompli-
cated hyperglycaemia (22.8%), severe hypoglycaemia (22.3%), and HHS (6%). 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.

N. Lotter, S. Lahri, D.J. van Hoving

https://doi.org/10.1016/j.afjem.2021.05.004

21 May 2021

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