Stress hyperglycaemia among children with severe acute malnutrition admitted to Mmwanamugimu Nutrition Unit, Mulago Hospital

Abstract

Background Stress hyperglycaemia is a transient increase in blood glucose level during stressful events like infections/illness which has been described in critically ill and severely malnourished children. Recent studies have demonstrated increased risk of mortality in critically ill (non-diabetic) children who have stress hyperglycaemia. Objective: The objective of this study was to determine the prevalence, associated factors and outcome of stress hyperglycaemia among children with severe acute malnutrition admitted to Mwanamugimu nutrition unit of Mulago hospital. Methodology: This was a cross-sectional study conducted from August to October 2015 at the Mwanamugimu nutrition unit of Mulago hospital among admitted children with SAM aged 1 to 60 months. Permission to conduct the study was obtained from the School of Medicine Research and Ethics Committee (SOMREC) and written consent obtained from the care givers. Random blood sugar levels were measured in these children. Stress hyperglycaemia was considered as a random blood sugar of >150mg/dl. The final outcome of the children was obtained by reviewing their charts on death or discharge. Statistical analysis was done using Pearson Chi square analysis and logistic regression. Results: Two hundred and thirty five children were enrolled into the study with a male to female ratio of 1:1 and average age of 15.1 months (Range 1-60 months). Stress hyperglycaemia was present in 16.6% of the 235 participants. A number of factors were significantly associated with stress hyperglycaemia at bivariate analysis but on logistic regression, only one factor was independently associated with stress hyperglycaemia and that is presence of oral sores

(OR 2.611, CI 1.02 to 6.65). The mortality was significantly higher among the children with stress hyperglycaemia (56.4%) compared to (12.8%) in the non-hyperglycaemic group (OR 8.748, CI 4.09 to 18.7). Conclusions and Recommendations The overall prevalence of stress hyperglycaemia was 16.6% and was associated with high mortality among these children. It is thus important to monitor the blood glucose levels of these children during admission especially for the children who have other complications like oral sores. Possible ways of preventing and managing stress hyperglycaemia are urgently needed.