Spectrum of Precipitating Factors for Hyperosmolar Hyperglycemic State in Diabetic Patients with Poor Adherence

Abstract

Background: Hyperosmolar Hyperglycemic State (HHS) is a life-threatening diabetes complication characterized by extreme hyperglycemia, hyperosmolarity, and severe dehydration. Poor adherence to diabetes management significantly increases the risk of HHS. This study identifies and categorizes precipitating factors for HHS in diabetic patients with poor adherence.

Methods: This retrospective observational study reviewed medical records of diabetic patients hospitalized for HHS over the past two years at a tertiary care hospital from Dec, 2021 to Dec 2023. Included patients had documented poor adherence to diabetes management. Data collected encompassed demographic information, clinical presentation, laboratory findings, and identified precipitating factors.

Results: The analysis identified diverse factors contributing to HHS, primarily infections (45%), chronic conditions (39%), corticosteroid use (17%), diuretic use (15%), medication noncompliance (60%), and dietary indiscretions (35%). Laboratory findings showed an average blood glucose level of 700 ± 100 mg/dL. The mortality rate was 12%, with acute kidney injury in 28% of patients, electrolyte imbalances in 40%, and acute respiratory distress syndrome (ARDS) in 6%. The mean hospital stay was 15.5 ± 2.5 days, with males generally experiencing longer stays.

Conclusion: The findings underscore the multifactorial etiology of HHS in diabetic patients with poor adherence to management plans. Infections, behavioral factors, and certain medications were significant contributors. Preventing HHS requires a comprehensive approach addressing medical, pharmacological, and behavioral components. Effective patient education, regular follow-up, and proactive management of risk ^factors are crucial in reducing HHS incidence.

Keywords: Hyperosmolar Hyperglycemic State, Diabetes, Poor Adherence, Precipitating Factors, Infections, Medications.