Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting

Sobngwi, Eugène; Lekoubou, A.L.; Dehayem, Mesmin; Nouthe, Brice; Balti, Eric Vounsia; Nwatsock, F.; Akwo, Elvis A; Effoe, Valery; Balla, Vanessa; Mamdjokam, A.S.; Siaha, Valentin; Tabi, C.A.; Mvom, A.; Djam, I.; Mbanya, Jean Claude

doi:10.1016/j.diabet.2009.04.006

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…The simple insulin therapy protocol as applied in this study was based on the one recently introduced in our setting,2 used for treatment of hyperglycemic emergencies. Oral rehydration was better suited to this therapy's ambulatory nature, as it was easier to perform, and none of the admitted patients showed signs of severe dehydration.…”

Section: Discussionmentioning

confidence: 99%

“…For all the study subjects, the treatment was initiated using an intensive intramuscular insulin therapy, 2 and rehydration was performed according to the clinical assessment of the level of dehydration and the monitoring of blood glucose and urine ketones. An intramuscular dose of insulin was given every hour depending on blood glucose levels (10 IU for blood glucose levels above 22 mmol/L, and 5 IU for blood glucose levels between 13.75 and 21.94 mmol/L), combined with rehydration as needed and follow-up of ketonuria.…”

Section: Methodsmentioning

confidence: 99%

“…Ketosis is recognized as one of the major complications of diabetes with respect to severity and urgency for care 1. It is a leading cause of death in people with diabetes (2%-5% mortality rate)2 3 and usually occurs in people with type 1 diabetes mellitus (T1DM). Among African American and sub-Saharan African patients, this complication is one of the main circumstances of diagnosis of diabetes among mature patients, particularly in ketosis-prone atypical diabetes (KPD) 4.…”

Section: Introductionmentioning

confidence: 99%

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Use of Capillary Ketones Monitoring in Treatment of Mild Ketotic Crisis in People with Ketosis-Prone Atypical Diabetes

Sobngwi

Ngai

Etoga

et al. 2020

Journal of Investigative Medicine

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This study was carried out to assess the potential reduction in duration of intensive diabetic ketoacidosis treatment in adults with ketosis-prone atypical diabetes (KPD) when using capillary versus urinary ketones. In this cross-sectional study, we included 20 people with KPD presented at the National Obesity Center of the Yaoundé Central Hospital with hyperglycemic decompensation (random capillary glucose ≥13 mmol/L) and significant ketosis (ketonuria≥++) requiring intensive insulin treatment. In all subjects, intensive insulin treatment was initiated at 10 UI per hour with simultaneous measurement of capillary beta-hydroxybutyrate and ketonuria every 2 hours until disappearance of ketonuria. Time-to-disappearance of urine ketones was compared with the time-to-normalization of capillary β-hydroxybutyrate concentrations. Subjects were aged 46±13 years with a median duration of diabetes of 1.5 (IQR: 0–2.5) years. On admission, the mean blood glucose was 22.8±5 mmol/L and capillary ketones level was 2.9±2.7 mmol/L. The median time-to-disappearance of ketonuria was 5 (IQR: 3–8) hours compared with the time-to-normalization of capillary β-hydroxybutyrate of 4 (IQR: 2–6) hours, p=0.0002. The absolute difference in time-to-normalization of ketonuria versus ketonemia was 2 (IQR: 1–3) hours and the relative time reduction of treatment was 32.5%±18.0%. Our results suggested that the use of capillary ketones versus ketonuria would allow a significant reduction in duration of intensive insulin treatment by one third in people with KPD.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of Capillary Ketones Monitoring in Treatment of Mild Ketotic Crisis in People with Ketosis-Prone Atypical Diabetes

Sobngwi

Ngai

Etoga

et al. 2020

Journal of Investigative Medicine

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“…One of the peculiarities in Africa is that diabetes becomes the bed of many other debilitating conditions including tuberculosis, which makes its morbidity and mortality high. In Cameroon, only mortality related to acute metabolic complications has been reported (Sobngwi et al, 2009;Dehayem et al, 2008). Knowing the proportion and causes of death in people with diabetes, will enable health policy makers to better draft the management of these patients; hence reduce preventable deaths.…”

Section: Introductionmentioning

confidence: 99%

The burden of infection in diabetic patients living in sub-Saharan region: Case of Yaound Central Hospital, Cameroon

Etoga¹,

Dehayem²,

Boli³

et al. 2020

J. Diabetes Endocrinol.

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Diabetes and its complications are responsible for premature death. However, mortality linked to diabetes remains underestimated because many developing countries do not have data related to this affection. This study aimed to determine the causes of death in hospitalized diabetic patient in our context. We carried out a retrospective study in the Endocrine and Metabolic Disease Unit of the Yaoundé Central Hospital during a period of 36 months. We included all patients admitted in the unit with a diagnosis of diabetes and/or diabetic complication.Non diabetic patients were excluded. For statistical analysis, Kaplan-Meier cumulative survival plot was used to assess mortality over time and the log rank test to assess differences of the survival functions by group. Hazard ratios (HR) together with their 95% confidence interval (CI) were calculated from the Cox regression. We analyzed a total number of 1005 medical records. The total number of deaths recorded was 73 (40 men and 33 women). The mean age of hospitalized patients was 55 (±16) years; and 57 years for deceased patients.The main presenting complain on admission were: poor glycemic control in 653 (65%) cases followed by diabetes foot wounds: 150 (15%) and fever 85 (8.4%). Mortality rate during this period was 7.3%. Septic shock was the principal cause of death in 42.4% of deceased patients. The other causes were hyperosmolar Non ketotic States (19.1%) ketoacidosis (16.4%). However, 21.9% of patients died in the first 24 h of admission. In 47.9% of deceased patients diabetes was newly diagnosed. Infection remains a major problem and the principal cause of death in diabetes patients in our African context.

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Current literature in diabetes

2010

Diabetes Metabolism Res

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 26 sections: 1 Reviews; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Obesity; 7 Prediction and Prevention; 8 Intervention: a) General; b) Care; c) Drug Therapy; d)Economics; e) Gene therapy; f) Nursing; g) Nutrition; h) Surgery; i) Transplantation; 9 Pathology and Complications: a) General; b) Cardiovascular; c) Eye disease; d) Gestational and fetal; e) Neurological; f) Podiatrical; g) Renal; 10 Endocrinology & Metabolism; 11 Experimental Studies; 12 Diagnosis and Techniques. Within each section, articles are listed in alphabetical order with respect to author

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Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting

Cited by 8 publications

References 14 publications

Use of Capillary Ketones Monitoring in Treatment of Mild Ketotic Crisis in People with Ketosis-Prone Atypical Diabetes

Use of Capillary Ketones Monitoring in Treatment of Mild Ketotic Crisis in People with Ketosis-Prone Atypical Diabetes

The burden of infection in diabetic patients living in sub-Saharan region: Case of Yaound Central Hospital, Cameroon

Current literature in diabetes

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