Pointers to preventing hyperglycaemic emergencies in Soweto.

Sixty people with hyperglycaemia were admitted to Baragwanath Hospital as emergency patients during an 8-week study period in 1981, and one-quarter of them died in hospital. Many of these hyperglycaemic emergencies could have been prevented; 88% of the patients were known diabetics, one-third of whom required only oral hypoglycaemic agents for diabetic control. Sixty-one per cent of the patients had concomitant diseases, primarily infections. Earlier treatment might well have prevented deterioration of diabetic control, yet only 6% of the patients had attended the health services in the previous week in spite of recognizing that they were becoming progressively more ill. These patients were at high risk of subsequent admission, one-third of those discharged being readmitted within 3 months. Attendance compliance during a 3-month follow-up period was poor, and the discharged patients lacked the skills and knowledge necessary to maintain adequate diabetic control. One-quarter of those on insulin could not measure their dose correctly, most could not adequately test their urine and did not know what action to take if they had worsening symptoms of hyperglycaemia or developed intercurrent illness. Hyperglycaemic emergency admissions could be reduced by improving ambulatory diabetic services, thus saving costs of hospital care. Recommendations for improving the hospital service include maintaining a register of patients who have had hyperglycaemic emergencies and special care to ensure that they acquire the necessary knowledge and skills. Other methods of improving compliance regarding attendance and medication should be applied. These recommendations need to be implemented and their efficacy evaluated.