The clinical presentation and outcome of diabetic patients admitted to medical wards of Mulago Hospital Kampala, Uganda
Bateganya, Henry Moses
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BACKGROUND: Diabetes mellitus is a chronic disorder of carbohydrate, fat and protein metabolism presenting with both acute and chronic complications which if not addressed early or managed poorly can lead to debility and even death. These complications often necessitate admission and sometimes prolonged stay in hospital. OBJECTIVES: The aim of the study was to document the clinical presentation and hospital outcome of both new and previously diagnosed diabetic patients admitted the medical wards of mulago hospital. Specific aspects documented included, reasons for admission, level of diabetic control, prevalence of some selected common diabetic complications and outcome of hospitalization. DESIGN: A Descriptive longitudinal non-interventional study was undertaken with follow-up from admission to discharge. SETTING: General medical wards of Mulago hospital, the national referral hospital and teaching hospital for Makerere university medical school. OUTCOME MEASURES: Reasons for admission, glycaemic state, complications present and outcome of hospitalization. PATIENTS: All consecutive diabetic patients admitted to the three general medical and private wards between August 1 and November 15 were eligible if they satisfied the inclusion criteria. RESULTS: Overall 120 diabetic patients were recruited. These constituted 4.15% of all medical admissions. Of these, 69 (57.5%) were females and 51 (42.5%) were male. The mean age was 49.02 SD (+- 17.76) years. Their mean blood sugar at admission was 20.0 (+-9.0) mmol/L. The majority (84.5%) of the study participants had hyperglycemia (random blood sugar more than 7.8 mmol/L) at admission. However, the overall control was satisfactorily among 50.6% (HbA less thab 7) of the patients whose HbA levels were determined at admission. The commonest cause of admission was uncontrolled hyperglycaemia (48.3%), but infections were present in 27.5% of all the patients and the commonest were pneumonia (15%) and unary tract infections (11.8%). Diabetic ketoacidosis (DKA) was the cause of admission in 9.2% of the study subjects. However, 56.7% of all the subjects had long term diabetic complications with hypertension and peripheral neuropathy accounting for 53.8% and 38.3% respectively. There were 13 deaths accounting for 10.8% for the study population and 61.5% of the deaths were among patients with infections. The average length of hospitalization was 9.5 +-4 days but the longest stay was 56 days. Admission levels of blood glucose and HbA did not affect the outcome. CONCLUSIONS: The commonest cause of admission was uncontrolled diabetes (hyperglycaemia) though long-term complications and infections were also known. Most patients had a good long term glycaemic control. The mortality and length of hospitalization were similar to those of other African countries of similar economies to Uganda (Awad et al 2000).