Management of Chronic Uncontrolled Diabetes With Ketoacidosis and Hyperosmolar Hyperglycemic State

TL;DR

This paper reviews the management of two severe diabetes complications, DKA and HHS, emphasizing early diagnosis, treatment, and long-term strategies to improve patient outcomes.

Contribution

The paper provides an integrative review of management strategies for DKA and HHS, emphasizing proactive and patient-centered approaches.

Findings

DKA and HHS require distinct but overlapping management strategies, including fluid resuscitation and insulin therapy.

HHS has higher mortality rates than DKA due to delayed diagnosis and comorbidities.

Long-term strategies like continuous glucose monitoring and telemedicine can reduce recurrence and improve quality of life.

Abstract

Diabetes mellitus (DM) continues to pose a significant global health burden. Acute complications of diabetes are life-threatening conditions: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). DKA predominantly affects young and type 1 diabetic patients. It is characterized by metabolic acidosis and ketonemia. Older patients with type 2 diabetes are at a greater risk of developing HHS, which is marked by profound hyperglycaemia and hyperosmolarity without significant ketoacidosis.

This review highlights the integrative approach needed for effective management. Since both conditions share certain common features, it is important to distinguish between them and initiate appropriate treatment, including prompt fluid resuscitation, insulin therapy, and electrolyte correction. Identification and treatment of precipitating factors is vital. Post-acute care strategies include medical stabilization as well as long-term behavioral modifications, like structured diabetes education, psychosocial support, and implementation of technology-driven interventions (continuous glucose monitoring and telemedicine) to reduce recurrence. HHS has up to 20% higher mortality due to delayed diagnosis and comorbidities, while DKA’s acute fatality remains comparatively lower at 1-5%. Therefore, early identification, aggressive management, and coordinated long-term follow-up are essential. A shift from episodic care to proactive, patient-centered disease management may significantly improve outcomes and quality of life for individuals with chronic diabetes.

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