Factors Associated with Death in Subjects Admitted for a Diabetological Emergency: Experience of the Medical Clinic II of the Abass Ndao Hospital Center in Dakar (Senegal): Death in Diabetic Emergencies

Introduction: Metabolic and vascular emergencies constitute a risk of lethality in diabetic subjects admitted to hospital. The objective was to evaluate the factors associated with death in subjects admitted for a diabetological emer- gency to improve management. Materials and Methods: It was a 12-month retrospective, descriptive and analytical study at Dakar's Marc Sankale Diabetes Center. The study concerned any type of diabetics subjects admitted for a diabetological emergency. We evaluated the profile of diabetes, the patholo- gies found and factors associated with death. Results: We identified 697 cases of diabetic emergencies with a prevalence of 13.8%. The sex ratio (M/F) was 0.82, the mean age was 49.6 years, and the mean duration of diabetes was 7.1 years. The metabolic profile was hypoglycemia (11.3%), ketoacidosis (34.6%), and hyperosmolar hyperglycemia syndrome (5%). The associated pathologies were vascular (51.1%), infectious (65.3%), kidney function impairment (7.6%), anaemia (13.8%). During the follow-up, 94 patients died, as an annual fre- quency of 13.5% among diabetological emergencies. In univariate analysis, the factors significantly associated with death were age > 60 years [OR = 4.09 (2.6 - 6.41)], hyperglycemia [OR = 2.58 (1.50 - 4.4)], hyperosmolar hyperglycemia syndrome [OR = 10.5 (5.19 - 21.5)], septic diabetic foot [OR = 3.57 (2.24 - 5.66)]. Vascular pathologies that significantly associated with death were stroke [OR = 4.06 (2.10 - 7.81)], lower limb arteriopathy [OR = 3.25 (1.84 - 5.73)], cardiovascular collapse [OR = 6.85 (2.34 - 20)]. In addition to diabetes, the deceased patients had one (18%), two (34%) and at least three (45.7%) known factors of poor prognosis. Conclusion: Emergencies in diabetology remain frequent in our practice. The comorbidity (vascular and infectious) consti- tutes a risk of abnormally high death rate. A particular attention must concern on old diabetics subjects with several pathologies. (Authors)