Pattern of diabetes admissions in a Northern Nigerian tertiary health centre

Abstract

Background: The pattern of diabetes admissions in tertiary health care facilities in northern Nigeria is poorly documented. We aimed to review the clinical presentation, complications and mortality of diabetes admissions at the Aminu Kano Teaching Hospital (AKTH) Kano.

Methods: A retrospective review of cases of diabetes mellitus (DM) admitted into the medical wards of AKTH over 30 months was done. Data extracted from patients’ case notes, ward admission/discharge register and death certificates included total medical ward admissions, DM admissions and indications for admission, DM patients’ demographic and clinical / laboratory parameters, mortality rates and clinical outcome.

Results: Of the 3,157 patients admitted, 204 (6.46%) were diabetics. The mean (SD) age of DM patients was 54.32 (16.18) years (range 17 – 86 years); males 53.39 (15.91) years; females 55.11 (16.44) years. Of the 204 DM patients, 93(45.6%) were males while 111(54.4%) were females. Mean duration of DM was 6.53 (7.61) years. There were more Type 2 DM 168 (82.4%) than Type 1 DM 36 (17.6%) patients, p< 0.05. Mean body mass index of the DM patients was 26.41 (4.99) Kg/m2 (range 16.16 – 42.86). Most of the DM patients (83%) were admitted for hyperglycaemic emergencies with a mean admission random plasma glucose (RPG) of 21.32 (10.89) mmol/l which improved to 7.87 (4.34) mmol/l at discharge. Frequent indications for admission were sepsis 63(30.9%), hyperglycaemic hyper-osmolar state 29(14.2%), cerebrovascular accident 19(9.3%), DM foot ulcer 15(7.4%), diabetes ketoacidosis 15(7.4%), hypoglycaemia 12(5.9%), nephropathy 29(14.2%) and severe hypertension 22(10.8%). Chronic complications found in the DM admissions included peripheral
neuropathy 69(33.8%), CVA 19(9.3%), retinopathy 35(17.2%), nephropathy 29(14.2%), cataract 19(9.3%), DM Foot ulcer 15(7.4%), ischaemic heart disease 7(3.4%) and erectile dysfunction 6(2.9%). Total mortality rate among medical admissions was 16.04% with DM accounting for 2.6% of total deaths.

Conclusion: Most of the DM patients admitted on to the medical wards of AKTH have chronic complications of DM and were overweight. Acute metabolic complications of DM and sepsis were the main indications for admission and accounted for the common causes of death.

Keywords: Diabetes mellitus, admissions, pattern, tertiary healthcare, Northern Nigeria