Prognostic indices of diabetes mortality

Introduction: Diabetes mellitus is an important cause of morbidity and mortality worldwide and the burden associated with it is felt more in developing countries. Communicable diseases, as opposed to non-communicable diseases, remain a top priority in developing countries like Nigeria. This report sets out to highlight the current status of diabetes-related hospitalizations in Nigeria and also to make comparisons with past reports. This goal will be achieved primarily by determining the prognostic factors associated with diabetes mortality and also noting the duration of hospital stay for the major causes of diabetes deaths. Method: From January through December 2006, subjects with diabetes mellitus (DM) in a tertiary hospital in Nigeria were prospectively studied after admission to assess their short-term outcome which was defined as death. The total mortality, causes of death, associated complications and duration of hospital stay were noted. The predictive factors for DM morbidity were evaluated using chi test, logistic regression. Students t test was computed for quantitative data. Results: A total of 1,327 subjects were admitted to the Medical wards for the duration of the study and the crude death rate was 11%. DM related admissions made up 206 (15%) of all the medical admissions and the case fatality rate was 33 (16%). The most common reasons for DM admission were hyperglycaemic emergencies (HE), 88 (40%) and hypertension, 44 (21%). The most common causes of deaths were HE, 15 (46%) and DM foot ulcers (DFU), 10 (30%) while DFU and cerebrovascular accident (CVA) had the highest case fatality rates of 28% and 25% respectively. DFU had the most prolonged duration of admission ranging from 15-122 days. DFU, CVD and having type 2 DM were highly predictive of fatal outcomes. The odds ratio and 95% Cl for these factors were 4.5 (1.5-12.7), 3.0 (0. 9-9.92 and 3.1 (0.7-14) respectively. Conclusion: DFU and HE are potentially remediable causes of mortality in DM. DFU as seen by the prolonged hospital stay imposes a huge burden on health resources. Better and early intervention of DFU is necessary to reduce the resultant disease burden.