Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution

Abstract

Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious acute complications of diabetes mellitus. In this study, we investigated the clinical characteristics of elderly diabetic patients in a hyperglycemic emergency state. Methods: We reviewed the medical records of elderly patients admitted with a diagnosis of DKA and HHS over the past 5 years at the National Medical Center in Korea. Patients were divided into 3 groups: those with only DKA, those with only HHS, and those with both DKA and HHS. We assessed the clinical characteristics, economic vulnerability, precipitating factors, and hospital mortality. Results: Twenty-seven patients (31 episodes) fulfilled the inclusion criteria. Nineteen episodes occurred in male patients. The mean age, blood glucose, and glycosylated hemoglobin (HbA1c) were 78.9 years, 700.7 mg/dL, and 10.6%, respectively. The mean mortality rate was 22.5%; the mortality rates of the DKA only group, the HHS only group, and the group with both DKA and HHS were 10%, 23%, and 37.5%, respectively. DKA was diagnosed in 10 patients (32%), HHS was diagnosed in 13 patients (42%), and both DKA and HHS were diagnosed in 8 patients (26%). There was no relationship between age, sex, economic vulnerability, HbA1c, insulin use, and mortality rate. However, the mortality rate was higher than that of a previous report. Self-discontinuation of diabetes medication and infections are the most common precipitating factors. Conclusion: Elderly patients with diabetes are prone to experience hyperglycemic emergency and have a high mortality rate. Therefore, more focused education and a social medical service system for those with diabetes should be instituted.

The Authors Reply: Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution

“…We have read the letter about our recently published report, "Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution" 1) . If it was not clear how the authors distinguished between diabetic ketoacidosis (DKA) with hyperglycemic hyperosmolar state (HHS) and mild DKA, patients were defined as having both DKA and HHS if they had a serum osmotic pressure of 320 mOsm/kg or higher, as well as an arterial blood pH of less than 7.30 or a bicarbonate level of less than 18 mEq/L.…”