Academic literature on the topic 'Hyperglycemic hyperosmolar nonketotic coma'

Contextualização: As complicações agudas do diabetes, embora em grande parte evitáveis, apresentavam considerável mortalidade em diversas localidades do mundo no século passado. No Brasil, a organização do Sistema Único de Saúde pode ter resultado em importante queda na mortalidade por esta causa. Objetivos: Descrever a mortalidade por complicações agudas do diabetes no Brasil entre 1991 e 2010. Métodos: Os óbitos declarados no Sistema de Informações sobre Mortalidade por complicações agudas do diabetes (CID-9 249 e 250, seguidos pelos dígitos 1, 2 ou 3, e CID-10 E10 a E14, seguidos pelos dígitos 0 ou 1) foram corrigidos para causas mal definidas e sub-registro. A partir da população obtida do Instituto Brasileiro de Geografia e Estatística, foram calculadas taxas de mortalidade padronizadas de acordo com a população mundial. Correlações lineares foram realizadas para descrever a relação entre mortalidade e idade, e regressões Joinpoint foram utilizadas para descrever tendências. Resultados: Houve queda de 70,9% na mortalidade por complicações agudas do diabetes no Brasil entre 1991 e 2010, de 8,42 para 2,45 óbitos por 100.000 habitantes. A redução ocorreu em ambos os sexos, todas as faixas etárias, todas as regiões e quase todas as unidades federativas. O declínio foi menor nos últimos anos, quando as taxas já estavam bem mais baixas. A mortalidade aumentou exponencialmente com a idade e foi maior nas regiões Norte e Nordeste. Conclusões: A marcante redução na mortalidade por complicações agudas do diabetes no Brasil nas últimas duas décadas indica que a cobertura ampla e gratuita adotada pelo sistema nacional de saúde do Brasil, com disponibilização de insulina e organização do cuidado, foi capaz de reduzir substancialmente as complicações agudas dessa doença. Entretanto, considerando especialmente as iniquidades regionais existentes, ainda há espaço para redução na mortalidade por essas complicações no Brasil.
Background: Acute complications of diabetes, though largely preventable, presented considerable mortality in various locations around the world in the 20th Century. In Brazil, the organization of the national health system may have resulted in an important decline in this cause of mortality. Objectives: To describe mortality rates from acute complications of diabetes in Brazil from 1991 to 2010. Methods: The deaths reported in the Mortality Information System for acute complications of diabetes (ICD-9 249 and 250, followed by the digits 1, 2 or 3, and ICD-10 E10 to E14, followed by the digits 0 or 1) were corrected for ill-defined and under-reporting. Using the population obtained from national censuses, we calculated mortality rates standardized to the world population. Linear correlations were performed to describe the relationship between mortality and age, and Joinpoint regressions were used to characterize trends. Results: Mortality from acute complications of diabetes decreased 70.9%, from 8.42 to 2.45 deaths / 100000 inhabitants, in Brazil from 1991 to 2010. The reduction occurred in both sexes, all ages, all regions and almost all states. The decline was less marked in recent years. Mortality rates increased exponentially with age and were higher in the North and Northeast regions. Conclusions: The marked reduction in mortality from acute complications of diabetes in Brazil over the last two decades suggests that the universal coverage adopted by the national health system of Brazil, provided without charge and in an increasingly organized fashion, coupled with greater availability of insulin, was able to substantially reduce deaths due to the acute complications of diabetes. However, especially considering regional inequities, much room still exists for further reduction in mortality from these complications in Brazil.

Diabetic ketoacidosis (DKA) and hyperosmolar nonketotic state (HONK; also referred to, in the USA, as hyperglycaemic hyperosmolar state) are the two most serious, potentially fatal acute metabolic complications of diabetes mellitus. In the USA, the annual incidence rate for DKA ranges from 4.6 to 8 episodes per 1000 patients with diabetes of all ages, and 13.4 per 1000 patients in subjects younger than 30 years old (1). The incidence rate in the USA is comparable to the rates in Europe, with estimates of 13.6 per 1000 patients with type 1 diabetes in the UK (2), and 14.9 per 1000 patients with type 1 diabetes in Sweden (3). In the USA, hospitalization for DKA has risen by more than 30% in the last decade, with DKA accounting for approximately 1 35 000 hospital admissions in 2006 (4). The incidence of HONK is difficult to determine because of the lack of population–based studies and the multiple combined illnesses often found in these patients. In general, it is estimated that the rate of hospital admissions due to HONK is lower than it is for DKA and HONK accounts for less than 1% of all primary diabetic admissions (5). The mortality rate in patients with DKA has significantly decreased in experienced centres since the advent of low-dose insulin and appropriate fluid-/electrolyte-replacement protocols. Among adults with DKA in the USA, the overall mortality rate is less than 1% (4). A trend toward remarkable reduction in mortality from DKA has been reported in Europe as well, with one UK university recording no deaths among 46 patients who were admitted for DKA between 1997 and 1999 (2). The incidence and mortality of DKA remains high in developing countries, owing to socioeconomic factors. For instance, in Nairobi, Kenya, the incidence of DKA was about 80 per 1000 hospitalized diabetic patients in a study reported in 2005, and mortality rate was as high as 30% (6). The mortality rate of patients with HONK remains high even in the developed world, at approximately 11%. The prognosis of both conditions is substantially worsened with increased age, presence of coma, and hypotension (7). Despite threat to life, DKA is also expensive, with estimated annual direct and indirect cost of 2 billion US dollars (8).