Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting

E. Sobngwi, Alain Zingraff Lekoubou Looti, M. Y. Dehayem, B. E. Nouthe, E. V. Balti, F. Nwatsock, E. A. Akwo, V. S. Effoe, V. T. Balla, A. S. Mamdjokam, V. Siaha, C. A. Tabi, A. Mvom, I. Djam, J. C. Mbanya

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Management of hyperglycaemic crises requires expensive and labour-intensive procedures that are not achievable in all clinical settings. Intramuscular (IM) insulin therapy is a more feasible alternative, but remains insufficiently evaluated. We report here on an audit of clinical outcomes of a simple management protocol that involves IM insulin therapy, careful rehydration and inexpensive monitoring in a resource-limited setting. Methods: In June 2006, we began the routine use of a protocol based on IM insulin administration, careful rehydration and affordable monitoring for the management of hyperglycaemic crises in Yaoundé Central Hospital. Clinical records of patients admitted for hyperglycaemic crises 6 months before and 6 months after introduction of the protocol were independently coded and compared for clinical outcomes, including the 48-hour death rate as a primary endpoint. Secondary endpoints were blood glucose (BG) normalization and duration of hospital stay. Results: A total of 112 patients' files fulfilled the inclusion criteria, including 57 before and 55 after the introduction of the IM protocol (intervention). Patients of the pre-intervention group were aged 56.4 ± 2.1 years versus 53.9 ± 2.3 years in the intervention group (p = 0.41), with 23% versus 40%, respectively, with newly diagnosed diabetes (p = 0.05), and 45% versus 41%, respectively, with significant ketosis on admission (p = 0.84). As for the primary endpoint, 15.8% of the pre-intervention group died within 48 hours of admission versus 3.6% in the intervention group (p = 0.03). BG was normalized within 24 hours of admission in 28.1% patients of the pre-intervention group versus 90.9% of the intervention group (p < 0.001). However, the overall duration of hospitalization was similar in both groups. Septic shock, ketosis and high serum creatinine on admission were associated with poor outcomes in both groups. Conclusion: The proposed protocol using IM insulin can be safely used to treat hyperglycaemic crises, with mortality rates comparable to those in specialized centres in developed countries.

Original languageEnglish (US)
Pages (from-to)404-409
Number of pages6
JournalDiabetes and Metabolism
Volume35
Issue number5
DOIs
StatePublished - Nov 1 2009

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Insulin
Ketosis
Fluid Therapy
Blood Glucose
Clinical Audit
Mortality
Septic Shock
Developed Countries
Length of Stay
Creatinine
Hospitalization
Therapeutics
Serum

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Sobngwi, E. ; Lekoubou Looti, Alain Zingraff ; Dehayem, M. Y. ; Nouthe, B. E. ; Balti, E. V. ; Nwatsock, F. ; Akwo, E. A. ; Effoe, V. S. ; Balla, V. T. ; Mamdjokam, A. S. ; Siaha, V. ; Tabi, C. A. ; Mvom, A. ; Djam, I. ; Mbanya, J. C. / Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting. In: Diabetes and Metabolism. 2009 ; Vol. 35, No. 5. pp. 404-409.
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abstract = "Background: Management of hyperglycaemic crises requires expensive and labour-intensive procedures that are not achievable in all clinical settings. Intramuscular (IM) insulin therapy is a more feasible alternative, but remains insufficiently evaluated. We report here on an audit of clinical outcomes of a simple management protocol that involves IM insulin therapy, careful rehydration and inexpensive monitoring in a resource-limited setting. Methods: In June 2006, we began the routine use of a protocol based on IM insulin administration, careful rehydration and affordable monitoring for the management of hyperglycaemic crises in Yaound{\'e} Central Hospital. Clinical records of patients admitted for hyperglycaemic crises 6 months before and 6 months after introduction of the protocol were independently coded and compared for clinical outcomes, including the 48-hour death rate as a primary endpoint. Secondary endpoints were blood glucose (BG) normalization and duration of hospital stay. Results: A total of 112 patients' files fulfilled the inclusion criteria, including 57 before and 55 after the introduction of the IM protocol (intervention). Patients of the pre-intervention group were aged 56.4 ± 2.1 years versus 53.9 ± 2.3 years in the intervention group (p = 0.41), with 23{\%} versus 40{\%}, respectively, with newly diagnosed diabetes (p = 0.05), and 45{\%} versus 41{\%}, respectively, with significant ketosis on admission (p = 0.84). As for the primary endpoint, 15.8{\%} of the pre-intervention group died within 48 hours of admission versus 3.6{\%} in the intervention group (p = 0.03). BG was normalized within 24 hours of admission in 28.1{\%} patients of the pre-intervention group versus 90.9{\%} of the intervention group (p < 0.001). However, the overall duration of hospitalization was similar in both groups. Septic shock, ketosis and high serum creatinine on admission were associated with poor outcomes in both groups. Conclusion: The proposed protocol using IM insulin can be safely used to treat hyperglycaemic crises, with mortality rates comparable to those in specialized centres in developed countries.",
author = "E. Sobngwi and {Lekoubou Looti}, {Alain Zingraff} and Dehayem, {M. Y.} and Nouthe, {B. E.} and Balti, {E. V.} and F. Nwatsock and Akwo, {E. A.} and Effoe, {V. S.} and Balla, {V. T.} and Mamdjokam, {A. S.} and V. Siaha and Tabi, {C. A.} and A. Mvom and I. Djam and Mbanya, {J. C.}",
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Sobngwi, E, Lekoubou Looti, AZ, Dehayem, MY, Nouthe, BE, Balti, EV, Nwatsock, F, Akwo, EA, Effoe, VS, Balla, VT, Mamdjokam, AS, Siaha, V, Tabi, CA, Mvom, A, Djam, I & Mbanya, JC 2009, 'Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting', Diabetes and Metabolism, vol. 35, no. 5, pp. 404-409. https://doi.org/10.1016/j.diabet.2009.04.006

Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting. / Sobngwi, E.; Lekoubou Looti, Alain Zingraff; Dehayem, M. Y.; Nouthe, B. E.; Balti, E. V.; Nwatsock, F.; Akwo, E. A.; Effoe, V. S.; Balla, V. T.; Mamdjokam, A. S.; Siaha, V.; Tabi, C. A.; Mvom, A.; Djam, I.; Mbanya, J. C.

In: Diabetes and Metabolism, Vol. 35, No. 5, 01.11.2009, p. 404-409.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting

AU - Sobngwi, E.

AU - Lekoubou Looti, Alain Zingraff

AU - Dehayem, M. Y.

AU - Nouthe, B. E.

AU - Balti, E. V.

AU - Nwatsock, F.

AU - Akwo, E. A.

AU - Effoe, V. S.

AU - Balla, V. T.

AU - Mamdjokam, A. S.

AU - Siaha, V.

AU - Tabi, C. A.

AU - Mvom, A.

AU - Djam, I.

AU - Mbanya, J. C.

PY - 2009/11/1

Y1 - 2009/11/1

N2 - Background: Management of hyperglycaemic crises requires expensive and labour-intensive procedures that are not achievable in all clinical settings. Intramuscular (IM) insulin therapy is a more feasible alternative, but remains insufficiently evaluated. We report here on an audit of clinical outcomes of a simple management protocol that involves IM insulin therapy, careful rehydration and inexpensive monitoring in a resource-limited setting. Methods: In June 2006, we began the routine use of a protocol based on IM insulin administration, careful rehydration and affordable monitoring for the management of hyperglycaemic crises in Yaoundé Central Hospital. Clinical records of patients admitted for hyperglycaemic crises 6 months before and 6 months after introduction of the protocol were independently coded and compared for clinical outcomes, including the 48-hour death rate as a primary endpoint. Secondary endpoints were blood glucose (BG) normalization and duration of hospital stay. Results: A total of 112 patients' files fulfilled the inclusion criteria, including 57 before and 55 after the introduction of the IM protocol (intervention). Patients of the pre-intervention group were aged 56.4 ± 2.1 years versus 53.9 ± 2.3 years in the intervention group (p = 0.41), with 23% versus 40%, respectively, with newly diagnosed diabetes (p = 0.05), and 45% versus 41%, respectively, with significant ketosis on admission (p = 0.84). As for the primary endpoint, 15.8% of the pre-intervention group died within 48 hours of admission versus 3.6% in the intervention group (p = 0.03). BG was normalized within 24 hours of admission in 28.1% patients of the pre-intervention group versus 90.9% of the intervention group (p < 0.001). However, the overall duration of hospitalization was similar in both groups. Septic shock, ketosis and high serum creatinine on admission were associated with poor outcomes in both groups. Conclusion: The proposed protocol using IM insulin can be safely used to treat hyperglycaemic crises, with mortality rates comparable to those in specialized centres in developed countries.

AB - Background: Management of hyperglycaemic crises requires expensive and labour-intensive procedures that are not achievable in all clinical settings. Intramuscular (IM) insulin therapy is a more feasible alternative, but remains insufficiently evaluated. We report here on an audit of clinical outcomes of a simple management protocol that involves IM insulin therapy, careful rehydration and inexpensive monitoring in a resource-limited setting. Methods: In June 2006, we began the routine use of a protocol based on IM insulin administration, careful rehydration and affordable monitoring for the management of hyperglycaemic crises in Yaoundé Central Hospital. Clinical records of patients admitted for hyperglycaemic crises 6 months before and 6 months after introduction of the protocol were independently coded and compared for clinical outcomes, including the 48-hour death rate as a primary endpoint. Secondary endpoints were blood glucose (BG) normalization and duration of hospital stay. Results: A total of 112 patients' files fulfilled the inclusion criteria, including 57 before and 55 after the introduction of the IM protocol (intervention). Patients of the pre-intervention group were aged 56.4 ± 2.1 years versus 53.9 ± 2.3 years in the intervention group (p = 0.41), with 23% versus 40%, respectively, with newly diagnosed diabetes (p = 0.05), and 45% versus 41%, respectively, with significant ketosis on admission (p = 0.84). As for the primary endpoint, 15.8% of the pre-intervention group died within 48 hours of admission versus 3.6% in the intervention group (p = 0.03). BG was normalized within 24 hours of admission in 28.1% patients of the pre-intervention group versus 90.9% of the intervention group (p < 0.001). However, the overall duration of hospitalization was similar in both groups. Septic shock, ketosis and high serum creatinine on admission were associated with poor outcomes in both groups. Conclusion: The proposed protocol using IM insulin can be safely used to treat hyperglycaemic crises, with mortality rates comparable to those in specialized centres in developed countries.

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