CLINICAL CHARACTERISTICS AND OUTCOME OF HYPERGLYCEMIC EMERGENCIES IN JOHANNESBURG AFRICANS

In this prospective analysis we investigated the clinical characterist ics of black South African diabetic patients admitted to hospital with hyperglycaemic emergencies. The study cases were selected from the me dical admissions to an urbanized, Johannesburg academic hospital over a period of 12 months. Only patients with severe diabetic ketoacidosis (DKA) or hyperosmolar non-ketotic hyperglycaemia (HNKH) as defined in the text were included. Over the study period, we identified 58 patie nts with severe DKA (M: 32, F: 26) and 24 with HNKH (M: 14, F:10). Thi rty-two of the patients with DKA (55.2 %) were classified as having no n-insulin dependent (Type 2) diabetes mellitus (NIDDM). Compared to th e 26 subjects with insulin-dependent (Type 1) diabetes mellitus (IDDM) , the NIDDM patients were older (51.7 vs 27.7 years) and had a signifi cantly higher body mass index (BMI) (29.4 vs 23.5 kg m(-2), p = 0.002) , and glucose levels 47.5 vs 34 mmol l(-1) p = 0.004). Mortality from DKA was 6.8 % and from HNKH 16.6 % Infection was the leading precipita ting factor for both DKA and HNKH, followed by first presentation and noncompliance. We conclude that the majority of urban African patients admitted to hospital with DKA have NIDDM. Mortality from DKA among th e black Africans in Johannesburg is low and comparable to the mortalit y in western Europe. (C) 1997 by John Wiley & Sons, Ltd.