Prevalence and treatment-related outcome of hospitalized type 2 diabetes mellitus patients with comorbidities at Helen Joseph Academic Hospital in Johannesburg

Abstract

BACKGROUND: Diabetic patients with comorbidities, have an increased risk of morbidity and mortality which leads to higher hospitalization and an overall increase in healthcare expenditure. Most of these patients, do not achieve the required glycaemic control (HbA1c <7%) even when they are on treatment.Identification of comorbidities in T2DM patients will allow for more comprehensive care of these high-risk individuals. On admission to the hospital T2DM patients are often undertreated for their cardiovascular risk factors leading to higher hospitalization rates, and an overall increase in healthcare expenditure. AIM: This study sought to investigate the control of modifiable risk factors in hospitalised T2DM patients, with and without comorbidities at Helen Joseph Academic Hospital. METHOD: A retrospective chart review study which analysed 246 files of T2DM patients ≥ 18 years, admitted in 2019 at Helen Joseph Academic Hospital was conducted. Files were randomly selected from the files department at Helen Joseph Hospital. Data were summarized using descriptive statistics. RESULTS: Two hundred and forty-six files of T2DM patients admitted in 2019, from Helen Joseph Academic Hospital with a mean (SD) age of 52 ± 13.4 years were investigated. In this cohort of patients, the comorbidity profile was found to be 73%, the majority of whom were female at 51%. Of the 73% of T2DM patients with comorbidities, 30% also presented with complications. The dominant concordant disease identified was hypertension, while the dominant discordant disease with the majority was HIV. The majority of T2DM patients (63%) were hospitalized, due to diabetes-related conditions with metformin being the most prescribed antidiabetic medication. CONCLUSION: There is a high prevalence of comorbidity in T2DM patients who were hospitalized at Helen Joseph Hospital. The hospitalization reasons were found to be `predominantly diabetic-related and required high care treatment. The HbA1c as a measure of glucose control over three months could not show any significant difference in patients with and without comorbidities. The BP was higher in T2DM patients with comorbidity than in those without. The majority of T2DM patients had diabetes related conditions as the reasons for their admission. Moreover, patients with comorbidities required high care and specialist services more often than those without. Intensive screening of known concordant diseases like hypertension and cholesterol in T2DM patients on coming for their routine clinic visits could assist in early detection and prevention of worsening comorbidities and ultimately preventing unnecessary hospitalizations.