Prevalence and Associated Clinical Parameters of a Hyperglycemic Emergency among Type 2 Diabetic Patients: A Nationwide Cross-Sectional Study in Thailand
Jitjira Chaiyarit PhD1, Thongchai Pratipanawatr MD2
Affiliation : 1 Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand 2 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : A hyperglycemic emergency is a major acute complication among diabetics with high morbidity and hospital
admission. In Thailand, the impact of hyperglycemic emergency has received scant attention.
Objective : The objectives of the current study were to explore the prevalence of hyperglycemic emergency and to identify
the association between clinical parameters and hyperglycemic emergency among patients with type 2 diabetes in Thailand.
Materials and Methods : The present study was a cross-sectional study and utilized data from the national evaluation of care
among type 2 diabetes and hypertension attending in hospitals of Ministry of Public Health and Bangkok Metropolitan
Administration of Thailand (DMHT project) that was conducted between 2012 and 2015. Included were 255,133 registered
diabetics. Multi-level, mixed-effects, logistic regression analysis was performed to determine the potential clinical parameters
associated with a hyperglycemic emergency.
Results : Among the 121,527 type 2 diabetics included, the overall prevalence of hyperglycemic emergency was 3.51% (95%
CI: 3.41 to 3.61). The increased risk of hyperglycemic emergency was significantly associated with (a) a lower BMI
(adjusted OR 1.88; 95% CI: 1.58 to 2.24), (b) a higher HbA1c, (c) anti-hyperglycemic agents particularly taking insulin
(adjusted ORinsulin 5.35; 95% CI: 4.42 to 6.48), (d) poor kidney function (adjusted ORstage 3 1.38; 95% CI: 1.26 to 1.52 and
adjusted ORstage 4-5 1.38; 95% CI: 1.18 to 1.60), (e) albuminuria (adjusted OR 1.23; 95% CI: 1.12 to 1.34), (f) previous
cerebrovascular disease (adjusted OR 1.52; 95% CI: 1.20 to 1.92), (g) previous coronary disease (adjusted OR 1.36; 95% CI:
1.13 to 2.24), and (h) previous congestive heart failure (adjusted OR 1.70; 95% CI: 1.29 to 2.24).
Conclusion : According to results, these factors; a lower BMI, a higher HbA1c, anti-hyperglycemic agents, poor kidney
function, albuminuria, previous cerebrovascular disease, coronary disease, and congestive heart failure found to be independently
associated with risk of hyperglycemic emergency. Therefore, this information will inform clinical decision-making with
respect to appropriate care and monitoring of diabetics.
Keywords : Clinical parameters, Hyperglycemic emergency, Type 2 diabetes
