Incidence and risk factors of hyperglycemic emergencies in adults with diabetes in the public hospitals in Harari region, Eastern Ethiopia

Hyperglycemic emergencies are the most common life-threatening acute metabolic complications of diabetes mellitus. The number of hyperglycemic emergency admissions over the past decade has increased worldwide, with recent data reporting a 55% increase in the rate of diabetic ketoacidosis hospitalizations. Therefore, this study aimed to determine the incidence and predictors of hyperglycemic emergencies among adult diabetic patients at public hospitals in the Harari Region, Eastern Ethiopia. A retrospective cohort study was conducted among 496 adults with diabetes. Data were collected using the Kobo toolbox and analyzed using STATA. The Kaplan-Meier curve and log-rank test were used to estimate the survival probability and statistically test survival between different categories, respectively. Predictors of hyperglycemic emergencies were determined using the Cox proportional hazard regression model. Hazard ratios (HR) with their respective 95% confidence interval (CI) and p-value were computed. Of the 472 patients included in the study, 34.11% (95% CI: 29.96%-38.52%) developed hyperglycemic emergencies. The incidence rate of hyperglycemic emergencies was 18.6 per 100 person-years observation (95%CI: 15.9-21.7). The median hyperglycemic emergency-free survival time was 51.06 months (95% CI: 45.14-58.56). Being a rural area residents (Adjusted Hazard Ratio(AHR): 1.52, 95% CI: 1.07,2.16), not having community health insurance (AHR: 1.63, 95% CI: 1.14-2.34), experiencing acute recent illness (AHR: 2.15, 95% CI: 1.51,3.07), having type 1 diabetes mellitus (AHR: 1.97, 95% CI: 1.23,3.15), having poorly controlled blood glucose (AHR: 3.06, 95% CI: 2.01,4.66), non-adherence with diabetes medication (AHR: 2.25, 95% CI: 1.55,3.26), being obese (AHR: 3.75, 95% CI: 1.84,7.64) and overweight (AHR: 2.56, 95% CI: 1.72,3.81) were factors significantly associated with hyperglycemic emergencies. The findings demonstrated that the incidence of hyperglycemic emergencies was high. Hence, special emphasis should be placed on follow-up care for diabetic patients with identified predictors to reduce the occurrence of these emergencies.