Epidemiological specificities of acute metabolic decompensation in diabetes: Case of tertiary healthcare center in Tunisia

Introduction Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. It is considered a major public health problem with significant social and economic consequences. Yet, it continues to have an upward trend worldwide. Acute complications of diabetes remain relatively frequent, for which these patients continue to consult the emergencies. It can lead to increase morbidity and mortality if not efficiently and effectively treated. The aim of this work is to specify the epidemiological and some clinical characteristics of patients consultants at the emergency department of the university hospital center Farhat Hached of Sousse (Tunisia) for acute complications. Materials and methods We conducted a prospective study of 168 consecutive patients who were admitted to emergency department at the Farhat Hached University Hospital Center, Sousse, Tunisia between January 2016 and July 2016 for acute decompensation of diabetes and whose age is older than 15 years. We included the five types of acute complication diabetic has to know: the hyperglycemia, hypoglycemia, the hyperglycemic hyperosmolar state, the ketosis and the ketoacidosis. Study was performed using a pre-tested questionnaire completed by the doctor at emergency department. Main sources of data were patients’ medical records, anamnesis and clinical examination. Variables measured were related to: patients’ general characteristics, clinical profiles, etc. For each estimate, a confidence interval was calculated according to the conventional formula. When the application conditions of the conventional formula were not met, the Wilson procedure with continuity correction was used. Results The mean age of patients was 45 ± 17.7 years. Almost 83.9% of them were under the age of 65 years with extremes ranging from 16 to 87 years and predominately female (53.6%). Among all cases, 35.7% reported that they fortuitous discovered that they are diabetic versus 64.3% who are already diagnosed with diabetes. According the type of diabetes, we noted that type 1 diabetes mellitus (T1DM) were more frequent than type 2 (T2DM) (59.25% versus 40.75%), 71 patients (65.74%) were treated by insulin including 27 patients with T2DM. The proportions of acute complications in decreasing order were ketosis (36%), ketoacidosis (30%), hyperglycemia (25%), hypoglycemia (25%) and finally hyperglycemic hyperosmolar state (2%). Concerning hypoglycemia, it was significantly predominant in T1DM ( P  = 0.004). Thus, no cases of lactic acidosis has been noted in our cohort. The major reasons of consultations were no specific one such as fever, chest pain (25.6%) and deterioration of general status (20.8%). Inaugural diabetes and poor compliance to treatment were mostly the precipitating causes of acute complications with percentages of 32.2% and 31.6%, respectively. Furthermore, anamnesis and clinical examination revealed that 37.9% of patients were at degenerative complications stage. One case of death at emergency was reported. Conclusion Diabetic Ketosis and ketoacidosis are still frequent complications and commonly encountered medical emergencies among patients with diabetes mellitus. Hypoglycemia is significantly more observed with T1DM. Henceforth, diabetes and its complications are preventable. More emphasis is required in order to decrease the prevalence of diabetes and to improve the prognosis in the short- and long-term. This concern should be shared by all healthcare providers and not be limited only to clinical experts.