Is Our Understanding of Hyperosmolar Hyperglycemic State Accurate?

Area of Science:

• Endocrinology
• Internal Medicine
• Critical Care Medicine

Background:

• Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are distinct hyperglycemic emergencies.
• HHS has higher mortality rates than DKA, yet optimal treatment strategies remain undefined.
• Current DKA protocols are often applied to HHS, lacking HHS-specific evidence.

Purpose of the Study:

• Compare clinical characteristics and outcomes of HHS and DKA.
• Identify factors contributing to higher HHS mortality.
• Inform the development of effective HHS treatment strategies to reduce mortality.

Main Methods:

• Retrospective analysis of adult patients admitted with HHS or DKA between 2015-2021.
• Comparison of clinical characteristics and outcomes between HHS and DKA groups.
• Primary outcome: in-hospital mortality.

Main Results:

• Study included 608 patients (223 HHS, 385 DKA).
• HHS patients were older, more frequently had infection as a trigger, and presented with more comorbidities.
• Univariate analysis showed higher in-hospital mortality in HHS (41.2% vs. 4.7%), but matched multivariate analysis revealed no significant difference.

Conclusions:

• Metabolic abnormalities alone do not explain worse HHS outcomes compared to DKA.
• Baseline comorbidities, age, and infection trigger significantly impact outcomes in hyperglycemic emergencies.
• Further research is needed to elucidate HHS-specific factors influencing mortality.