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Hyperglycemic crises in urban blacks

G E Umpierrez¹, J P Kelly, J E Navarrete

¹Department of Medicine, Emory University School of Medicine, Atlanta, Ga, USA.

Archives of Internal Medicine

|March 24, 1997

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Poor compliance with insulin therapy and substance abuse are key factors in diabetic emergencies like DKA and HHNS among urban Black patients. Improving education and access to care can help prevent these hyperglycemic crises.

Area of Science:

Endocrinology
Public Health
Internal Medicine

Background:

Diabetic emergencies, including diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS), exhibit higher admission and mortality rates in Black patients compared to White patients.
Limited data exists on the precipitating events and treatment responses in Black patients experiencing these acute metabolic complications.
Analysis of clinical characteristics and treatment responses is crucial for developing targeted interventions to reduce complications.

Purpose of the Study:

To analyze the clinical characteristics of diabetic emergencies in urban Black patients.
To identify precipitating events leading to DKA and HHNS in this population.
To evaluate the response to medical therapy and the impact of treatment protocols.

Main Methods:

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A prospective study evaluated 144 consecutive patients with DKA and 23 with HHNS admitted to an inner-city hospital.
Data collected included precipitating events, comorbidities, and treatment protocols used.
Treatment involved a low-dose insulin protocol with an adjustment algorithm in a subset of patients.

Main Results:

Poor compliance with insulin therapy was the primary cause of DKA (49%) and HHNS (42%).
Substance abuse (alcohol/cocaine) was a significant contributing factor to noncompliance (35% DKA, 44% HHNS).
Obesity was prevalent, particularly in newly diagnosed DKA patients (56%). The low-dose insulin protocol reduced hypoglycemia risk (5% vs. 23%).

Conclusions:

Poor insulin compliance and substance abuse are major triggers for acute metabolic decompensation in urban Black patients.
Obesity is common in Black patients with DKA, especially those newly diagnosed.
Enhanced patient education and improved healthcare access are recommended to mitigate hyperglycemic emergencies.