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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting
Diabetes and Metabolism, Volume 35, No. 5, Year 2009
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Description
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. © 2009.
Authors & Co-Authors
Sobngwi, Eugène
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
United Kingdom, Newcastle
University of Newcastle Upon Tyne, Faculty of Medical Sciences
Lekoubou, Alain L.
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Dehayem, Mesmin Yefou
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Nouthé, Brice Enid
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Balti Vounsia, Eric
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Nwatsock, F.
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Akwo, Elvis Abang
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Effoe, Valery Sammah
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Balla, Vanessa
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Mamdjokam, A. S.
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Siaha, Valentin
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Tabi, C. A.
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Mvom, Angeline
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Djam, I.
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Mbanya, J. C.
Cameroon, Yaounde
Central Hospital of Yaounde Fmbs
Cameroon, Yaounde
Université de Yaoundé I
Statistics
Citations: 15
Authors: 15
Affiliations: 3
Identifiers
Doi:
10.1016/j.diabet.2009.04.006
ISSN:
12623636
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial