The spectrum of coma among people with diabetes in Cameroon: an appraisal of the implications and challenges at the Yaounde Central Hospital

Abstract

The present study was undertaken to assess the prevalence and prognosis of comas, the most serious acute complications of diabetes, among people with diabetes in Cameroon. The medical records of diabetic patients admitted to the endocrinolgy service of the Yaounde Central Hospital between November 1999 and October 2002 were reviewed. For each patient, data were collected on past medical history, clinical parameters, results of laboratory investigations, treatment received, and outcome. Coma was found to account for 10.2% (52) of the 509 admissions of diabetic patients, and to be responsible for a diagnosis of diabetes in 11 patients. The underlying causes of the comas were hypoglycaemia (28.8%), ketoacidosis (25%), hyperosmolar syndrome (25%), stroke (5.8%), uraemic syndrome (5.8%) and meningitis (5.8%). Hypoglycaemia was treated with intravenous (10%) glucose. Careful rehydration and subcutaneous injections of low doses of regular insulin were used to manage the hyperglycaemic crises, and broad-spectrum antibiotics were used to treat the infections. Despite the treatments, 11 of the coma cases died in hospital, six (55%) of the deaths being ultimately attributed to infection. Diabetic comas are relatively frequent in Yaounde and sometimes the first indication that an individual is diabetic. Associated deaths are regularly the result of infection. The management of the comas, using techniques that are not particularly aggressive, generates outcomes similar to those reported elsewhere.