|
Introduction
Hospital admissions due to complications of diabetes mellitus are increasing day by day
and thus diabetes is becoming an important public health problem. This has prompted us to perform a retrospective study of various causes of death in diabetics, We looked in to the records of our hospital for this data presentation.
Materials and methods
750 beded, Maharaja Yaswant Rao Hospital Indore, caters mainly the patients of lower
and middle class of the society. For collecting the requisite information medical admission and death registers and case papers of all the diabetic patients admitted in the preceding 2 years from 01-Jan 95 to 31 -Dec-1996 in the department of medicine were brought out and looked into. The clinical histories noted on the out door slips and indoor record sheets, pre and post admission biochemical parameters, residents summaries and consultants comments for each diabetic patient were scrutinized.
Indication for admission, duration of diabetes, male and female ratio, glycemic control,
complications of diabetic and causes of death in diabetic patients were noted.
Glycemic control in the study was categorized according to fasting and postmeal blood
sugar values. Good glycemic control was when F.B.S. was 110 and post meal blood sugar (PPBS) 140 mg%. Fair glycemic control meant FBS 120 and PPBS between 140-180 mg%, while poor glycemic control was considered when FBS was 120 and PPBS 200 mg%.
Observations
After scrutinizing the medical admission, death records and casepapers, the following
observations were made.
1. Total patients admitted 15100
2. Total Diabetics admitted 645
3. Male : Female diabetic ratio 2.2:1
4. NIDDM : IDDM, Admission ratio 5:1.
5. Total No. of diabetic deaths 64
6. NIDDM: IDDM. Death ratio 5.5:1
The age of diabetic population ranged from 20-80 years and they constituted 4.3% of the
total medical admission. Deaths in early age were seen especially in IDDM group.
Male diabetics were 2 times more than females and their respective percentages were 69
& 31. About 10% of the diabetic patients died during their hospital stay.
| |
Mortality pattern |
in diabetics |
|
| |
Causes |
No. of Patients |
Percentage |
| 1. |
Cerebrovascular accidents |
22 |
34.37 |
| 2. |
Chronic renal failure |
10 |
15-62 |
| 3. |
Coronary artery disease |
08 |
12.5 |
| 4. |
COPD vith lung infection |
08 |
12.5 |
| 5. |
Diabetic ketoacidosis |
07 |
10.93 |
| 6. |
Other infections |
03 |
04.64 |
| 7. |
Acute renal failure |
01 |
01.56 |
| 8. |
Hvpoglvcemic coma |
01 |
01.56 |
| 9. |
Unrelated to diabetes |
04 |
06.25 |
| |
TOTAL |
64 |
100 |
Out of the total 64 diabetic deaths, 10 occurred in IDDM group. Vascular causes together constituted 62.5% of all diabetic death.
Duration of diabetes in diabetic deaths
| |
Duration |
Range |
| NIDDM |
12 years |
(02-22 yrs) |
| IDDM |
08 years |
(03-13 yrs) |
Glycemic control
(a) Preadmission record
| Category |
NIDDM (n=54) No. of Pts % |
IDDM (n=10) No. of Pts % |
| 1. Good control |
04 |
07.4 |
2 |
20 |
| 2. Fair control |
08 |
14.8 |
4 |
40 |
| 3. Poor control |
18 |
33.3 |
2 |
20 |
| 4. No information |
24 |
44.4 |
2 |
20 |
| Total |
54 |
100 |
10 |
100 |
(b) Post admission record
| Category |
MID DM (n=54) No. of Pts % |
IDDM (n=10> No. of Pts % |
| 1. Good |
3 |
5.5 |
0 |
0 |
| 2. Fair |
12 |
22.2 |
1 |
10 |
| 3. Poor |
39 |
72.2 |
9 |
90 |
| Total |
54 |
100 |
10 |
100 |
In majority of diabetic deaths preterminal glycemic control was poor
Discussion
Study revealed that diabetes mellitus accounted for 4% of total medical admissions and
10% of the diabetics died during their hospital stay.
Vascular causes together constituted 62.5% of diabetic deaths in the series. A similar high
rating of 57.% for vascular causes were also observed by Patel J.C. et at.l
Vascular diseases together accounted for 74% of diabetic death in "AIIMS diabetic
mortality data" reported by Ahuja M.M.S.2
In our series, out of the total 62.5% vascular causes of diabetic deaths, CVA & CAD as a
macro vascular complications accounted in 47% and CRF as a microvascular complications in 16% CRF as a cause of death in diabetics was observed in 15.5% by Vaishnava H et al (3). However it was observed in 40% of the diabetic deaths in "AIIMS diabetic mortality data", Probably being a referral center they had more diabetic nephropathy cases and also due to difference in the ratio of NIDDM & IDDM patients, duration of diabetes, economical status, age ranges etc. between present series & their study population. One of the case, in this study, died due to acute renal failure secondary to papillary necrosis.
Infections and diabetic ketoacidosis ranked next to vascular causes of diabetic death.
Diabetic ketoacidotic coma as a cause of death was observed in 11% of the Diabetic
deaths and it was seen mainly in IDDM group. Similarly NIDDM patients who had diabetic ketosis secondary to vascular event, were not smoothly responding to treatment. Death due to diabetic ketoacidosis was observed in 6.5% in AIIMS study.2
It was observed that about 1.6% diabetics died due to delayed treatment of hypoglycemic
coma, leading in to irreversible brain damage. Patel J.C. et al (4) observed, 4-7% diabetic deaths due to hypoglycemic coma. Proper patient's education regarding diet, hypoglycemic symptoms and immediate intervention will certainly prevent these hypoglycemic deaths.
Chest infection and other infections like koch's abdomen, cerebral malaria, cerebral
abscess constituted 17% of the all diabetic deaths. In AIIMS diabetic mortality study (2) they observed infection as a cause of death in 9.2% of the diabetic deaths, while it was seen in 14% by Patel J.C. et al (4) in their study.
Deaths, in diabetics, unrelated to diabetic complications, were due to rabies, viral hepatitis
& carcinoma oesophagus. The general characteristics of the population vary from place to place and hospital to hospital, however, statistics in regards to the pattern of mortality in diabetics are in general consistent with the other studies.
Conclusions
1. Vascular complications are the leading causes of diabetic deaths.
2. Infections and diabetic ketoacidotic coma rank next to vascular complications.
3. Better diabetic education will definitely help to prevent DKA in our country.
REFERENCES
1. Patel J.C and Gajwani R.K.: Diabetes in the tropics, proceedings of the world
congresson D.M. In the tropics. 419-420, Jan-1966.
2. Ahuja M.M.S., Diabetes care in clinical practice, Jaypee brother publications, 96-98,
1996.
3. Vaishnava H., Gupta S.C., Ajvani N.K., The causes of death in D.M., Diabetes in the
tropics, 413-416, 1966.
4. Patel J.C., Dhirwani M.K., Deshpande N.M., Causes of death in D.M. Diabetes in
tropics, 417-418,1966.
|
