Clinical Profile of Hyperosmolar Hyperglycemic State among Patients Presenting with Uncontrolled Type Ii Diabetes Mellitus

Abstract

Background: Hyperosmolar Hyperglycemic State (HHS) is a severe acute metabolic complication of diabetes mellitus characterized by marked hyperglycemia, hyperosmolarity and profound dehydration, with little or no ketosis. Early recognition and identification of precipitating factors are important in the clinical management of this emergency.
Aim: To assess the clinical profile of Hyperosmolar Hyperglycemic State in patients presenting with uncontrolled type II diabetes mellitus.
Methods: A cross-sectional study was conducted over 18 months in the Department of Casualty, General Medicine wards and ICU of Sree Balaji Medical College, Chennai. Patients with uncontrolled type 2 diabetes mellitus and clinical features suggestive of HHS were screened. Purposive sampling was used and 100 eligible patients were included. Demographic, clinical, comorbidity, precipitating-factor and biochemical data were recorded.
Results: The mean age was 54.31 ± 8.22 years and 70% were male. Mean BMI was 28.68 ± 1.71 kg/m²; 51% were in the 27.6–30.0 kg/m² category and 25% had BMI >30 kg/m². Sixty-three percent belonged to the lower income group. Pneumonia was reported in 45%, urinary tract infection in 28% and sepsis in 27%. Stroke, acute myocardial infarction and heart failure were reported in 56%, 27% and 17%, respectively. Mean blood glucose was 705.67 ± 67.33 mg/dL and mean serum osmolality was 505.23 ± 94.26 mOsm/kg. Clinical dehydration was present in 98% and altered mental status in 97%. Absence of ketosis was reported in all patients, with mean serum bicarbonate of 27.18 ± 5.15 mEq/L.
Conclusion: In this study population, HHS was characterized by severe hyperglycemia, hyperosmolarity, marked dehydration and frequent neurological manifestations. Infection, particularly pneumonia, was frequently reported, and cardiovascular and cerebrovascular events were also observed.