Incidence of Hyperglycemic Emergencies, Time to optimal glycemic control and associated Factors among Adult Diabetic Patients in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: A Retrospective Follow up Study

Abstract

Background: Hyperglycemic emergency is a serious acute complication of diabetes mellitus, and its health and economic impacts are high among adult diabetic patients. On the other hand, delayed achievement of optimal glycemic control is associated with a higher risk of diabetic complications. Therefore, this study aimed to assess the incidence of hyperglycemic emergencies, time to optimal glycemic control and associated factors among adult diabetic patients in University of Gondar comprehensive specialized hospital. Methods: A retrospective follow up study was conducted among 423 randomly selected diabetic patients who were diagnosed from January 1, 2018 to December 30, 2022 at University of Gondar comprehensive specialized hospital. Data was collected using data abstraction tool and exported to STATA version 17 for analysis. Logistic regression model and Cox proportional hazard regression modelwas fitted to identify predictors of incidence of hyperglycemic emergency and time to optimal glycaemic control respectively. Results: Out of 423 adult diabetic patients included in the study 124(29.31%) developed hyperglycaemic emergency. The overall incidence was 1.14 per 100-person month or 13.68 per 100 person years. Infection (AOR=2.66, 95%CI:1.55,4.54), Type II Diabetes mellitus (AOR=0.17, 95%CI:0.07,0.41), acute recent illness (AOR=3.45, 95%CI:1.49,7.96), comorbidity (AOR=3.36, 95%CI:1.74,6.5), medication noncompliance (AOR= 3.78, 95%CI: 1.96,7.29), and therapeutic inertia (AOR= 1.90, 95%CI: 1.05,3.45) were significant predictors of incidence of hyperglycaemic emergencies. Median time to first optimal glycemic control was 10.6 months. Age category (middle age (AHR=0.56, 95% CI=0.41,0.76), older age (AHR=0.49, 95% CI=0.32,0.79)), comorbidity (AHR=0.48, 95% CI=0.32,0.70), therapeutic inertia (AHR = 0.19, 95% CI=0.13,0.29), metformin dose at initiation (AHR=1.50,95% CI=1.13,1.99), and medication noncompliance (AHR=0.49(95% CI=0.27,0.88) were significant predictors of time to optimal glycemic control. Conclusion: The incidence of hyperglycemic emergency was found to be high. Considerable proportion of diabetic patients did not achieve optimal glycaemic control. The median time to optimal glycaemic control was 10.6 months which is longer than recommended. Diabetic care should focus on controlling the identified predictors to minimize the incidence of hyperglycaemic emergency and for early achievement of optimal glycaemic control.