Prehospital Care and Clinical Characteristics of Patients With Diabetic Emergencies at A Tertiary Care Hospital in Mysuru, India: An Observational Study with Emphasis on Geospatial Analysis

Priyanga Thirunavukkarasu; Madhu Basavegowda; Mounika Sree Manivasagan; Chaithra  Mallaiah; Aravindhan Ranganathan; Sulochanadevi  B Chakrashali

doi:10.55489/njcm.151120244553

Authors

Priyanga Thirunavukkarasu School of Public Health, JSS Medical College, JSS AHER, Mysuru, Karnataka, India
Madhu Basavegowda JSS Medical College, JSS AHER, Mysuru, Karnataka, India
Mounika Sree Manivasagan JSS Medical College, JSS AHER, Mysuru, Karnataka, India https://orcid.org/0000-0002-4133-9161
Chaithra Mallaiah JSS Medical College, JSS AHER, Mysuru, Karnataka, India https://orcid.org/0000-0003-2346-7191
Aravindhan Ranganathan School of Public Health, JSS Medical College, JSS AHER, Mysuru, Karnataka, India
Sulochanadevi B Chakrashali School of Public Health, JSS Medical College, JSS AHER, Mysuru, Karnataka, India https://orcid.org/0000-0002-4902-1879

DOI:

https://doi.org/10.55489/njcm.151120244553

Keywords:

Diabetic emergencies, Prehospital care, Health-seeking behavior, Diabetes Management, Emergency department, Geospatial analysis, Healthcare proximity

Abstract

Background: Diabetes Mellitus is a chronic, progressive disease with serious complications, and its prevalence is rising, especially in India. This study evaluates the clinical characteristics, prehospital care, and proximity to healthcare facilities among patients presenting with diabetic emergencies at a tertiary care hospital.

Methodology: A cross-sectional study was conducted with 70 diabetic emergency patients (hyperglycemia, hypoglycemia, and DKA). Data were collected using a semi-structured questionnaire assessing clinical characteristics, prehospital care, and health-seeking behavior. Geospatial analysis measured the distance from patients' residences to the hospital.

Results: Among the 70 participants, 36 (51.4%) were over 60 years old, and 55 (78.6%) were male. The most common symptoms were polyuria (85.7%) and excessive thirst (57.1%). Hyperglycemia was diagnosed in 68 (97.1%) cases, with 46 (65.7%) showing high random blood sugar levels (>200 mg/dl). Severe symptoms led 55 (78.6%) to seek emergency care, with 17 (24.3%) requiring ambulance services. Geospatial analysis revealed that 50% of patients lived 1-50 km from the hospital.

Conclusion: The study emphasizes the need for improved access to diabetes care near patients' homes to prevent emergencies, highlighting the importance of decentralizing services to improve health outcomes.

References

Diabetes - India [Internet]. [cited 2024 Jun 25]. Available from: https://www.who.int/india/health-topics/mobile-technology-for-preventing-ncds.

Noncommunicable Diseases - PAHO/WHO | Pan American Health Organization [Internet]. 2024 [cited 2024 May 6]. Available from: https://www.paho.org/en/topics/noncommunicable-diseases.

Lotter N, Lahri S, van Hoving DJ. The burden of diabetic emergencies on the resuscitation area of a district-level public hospital in Cape Town. Afr J Emerg Med. 2021;11(4):416-21. Doi: https://doi.org/10.1016/j.afjem.2021.05.004

IDF diabetes atlas [Internet]. Diabetesatlas.org. [cited 2024 Aug 2]. Available from: https://diabetesatlas.org/

Diabetic emergencies: What to do when someone is in a diabetes crisis [Internet]. WebMD. [cited 2024 Aug 2]. Available from: https://www.webmd.com/diabetes/diabetes-emergencies-what-to-do.

Iloh G, Amadi A. Epidemiology of diabetic emergencies in the adult emergency department of a tertiary hospital in south-eastern Nigeria. Int J Trop Dis Health. 2018;30(1):1-10. Doi: https://doi.org/10.9734/IJTDH/2018/28806

Duca LM, Wang B, Rewers M, Rewers A. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care. 2017;40(9):1249-55. Doi: https://doi.org/10.2337/dc17-0558

Curtis AJ, Lee W-AA. Spatial patterns of diabetes related health problems for vulnerable populations in Los Angeles. Int J Health Geogr. 2010;9(1):43. Doi: https://doi.org/10.1186/1476-072X-9-43

Bazargan M, Johnson KH, Stein JA. Emergency department utilization among Hispanic and African-American under-served patients with type 2 diabetes. Ethn Dis. 2003 Summer;13(3):369-75.

Ford W, Self WH, Slovis C, McNaughton CD. Diabetes in the emergency department and hospital: Acute care of diabetes patients. Curr Emerg Hosp Med Rep. 2013;1(1):1-9. Doi: https://doi.org/10.1007/s40138-012-0007-x

Villani M, Earnest A, Smith K, de Courten B, Zoungas S. Geographical variation of diabetic emergencies attended by prehospital Emergency Medical Services is associated with measures of ethnicity and socioeconomic status. Sci Rep. 2018;8(1). Doi: https://doi.org/10.1038/s41598-018-23457-5

Stansberry TT, Tran L, Myers C. Using Geographic Information Systems in health disparities research: Access to care considerations. Res Nurs Health. 2023;46(6):635-44. Doi: https://doi.org/10.1002/nur.22348

National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. [cited 2024 May 24]. Low Blood Glucose (Hypoglycemia) - NIDDK. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia.

Mouri Mi, Badireddy M. Hyperglycemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 May 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK430900/.

Diabetic Ketoacidosis - Signs & Symptoms | ADA [Internet]. [cited 2024 Jun 2]. Available from: https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones.

Diabetes Diagnosis & Tests | ADA [Internet]. [cited 2024 Jun 11]. Available from: https://diabetes.org/about-diabetes/diagnosis.

Yogesh, Venkatesan, Jayaraj, Karthigeyan, Prasath S, Prakash S, et al. Understanding the complexity of hyperglycemic emergencies: Exploring the influence of the type and duration of diabetes mellitus and its impact on mortality. Cureus [Internet]. 2024; Doi: https://doi.org/10.7759/cureus.58916

Bedaso A, Oltaye Z, Geja E, Ayalew M. Diabetic ketoacidosis among adult patients with diabetes mellitus admitted to emergency unit of Hawassa university comprehensive specialized hospital. BMC Res Notes. 2019;12(1):137. Doi: https://doi.org/10.1186/s13104-019-4186-3

Villani M, Earnest A, Smith K, Giannopoulos D, Soldatos G, de Courten B, et al. Outcomes of people with severe hypoglycaemia requiring prehospital emergency medical services management: a prospective study. Diabetologia. 2019;62(10):1868-79. Doi: https://doi.org/10.1007/s00125-019-4933-y

Hjelm K, Atwine F. Health-care seeking behaviour among persons with diabetes in Uganda: an interview study. BMC Int Health Hum Rights. 2011;11(1):11. Doi: https://doi.org/10.1186/1472-698X-11-11

Yan JW, Gushulak KM, Columbus MP, van Aarsen K, Hamelin AL, Wells GA, et al. Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus. Int J Emerg Med. 2017;10(1):23. Doi: https://doi.org/10.1186/s12245-017-0150-y

Tripura K, Nag K, Karmakar N, Datta A, Bhattacharjee P. A cross sectional study on the prevalence of diabetes mellitus among adult population in a peri-urban area of West Tripura, India. Int J Res Med Sci. 2019;7(3):843. Doi: https://doi.org/10.18203/2320-6012.ijrms20190934

Sumer Z, Rafique E, Soaib Said M, Saleem I, Zahid A, Bashir U, et al. Assessment of risk factors associated with diabetes. International Journal of Natural Medicine and Health Sciences. 2022;1(2):82-8. Doi: https://doi.org/10.52461/ijnms.v1i2.836

Lage MJ, Boye KS. The relationship between HbA1c reduction and healthcare costs among patients with type 2 diabetes: evidence from a U.S. claims database. Curr Med Res Opin. 2020;36(9):1441-7. Doi: https://doi.org/10.1080/03007995.2020.1787971

Olickal J, Devasia JT, Thekkur P, Chinnakali P, Suryanarayana BS, Kumar Saya G, et al. How far persons with diabetes travel for care? Spatial analysis from a tertiary care facility in Southern India. Ann GIS. 2021;27(4):341-9. Doi: https://doi.org/10.1080/19475683.2021.1966504