Reducing Acute Hyperglycaemic Mortality in African Diabetic Patients

Acute diabetic hyperglycaemic emergencies carry a high mortality in tropical countries. Defining a ‘hyperglycaemic emergency’ as the perceived need for intravenous insulin and saline, we found a mortality of 15/60 (25%) in a 2‐month period at Baragwanath Hospital, Soweto in 1981. Following this a programme of improved diabetes care was organized, involving optimization of insulin regimens, home blood glucose monitoring, patient education and concentration of resources on young insulin‐dependent patients. Five years later, in 1986, the survey was repeated over a similiar 2‐month period. The mortality this time was 5/48 (10%), a significant reduction compared with 1981 (p < 0.05). In addition, mean admission glycosylated haemoglobin fell from 11.8 ± 2.4(± SD) to 10.5 ± 2.3% (p < 0.05). These improvements were achieved by relatively simple and inexpensive manoeuvres which could be applied elsewhere in developing countries.