ACUTE DIABETIC COMPLICATIONS ATTENDED AT HOSPITAL EMERGENCY DEPARTMENT FROM 2010 TO 2018

Sa？etak Objective: Diabetes is one of the major health and socioeconomic problems in Croatia. According to data from the Croatian Institute of Public Health, over 300,000 patients with diabetes have been registered, with further increase in the number of patients. In 2017, diabetes was recognized as the ？ fth leading cause of death, accounting for 3.7% of total mortality. Diabetic ketoacidosis, hyperglycemic hyperosmolar condition, and hypoglycemia are serious complications of type 1 and type 2 diabetes, which also are the most common emergency conditions in endocrinology. Although diabetic ketoacidosis most commonly occurs in people with type 1 diabetes and hyperosmolar condition in those with type 2 diabetes, there is an increasing incidence of diabetic ketoacidosis in subjects with type 2 diabetes. The main aim of the research was to analyze the hypoglycemic and hyperglycemic crisis patients at Department of Emergency Medicine, Sveti Duh University Hospital, during the 2010-2018 period. Methods: The study population included a total of 175,446 adults examined at Emergency Department from January 1, 2010 until December 31, 2018, with plasma glucose values greater than 13.9 mmol/L or less than 3.9 mmol/L. Depending on the acid-base status, ketonuria and plasma osmolarity, patients were divided into four groups as follows: non-ketotic hyperglycemia, hypoglycemia in diabetes, diabetic ketoacidosis, and hyperosmolar hyperglycemic state. Patients were also divided according to age and type of diabetes. Results: At 3,773 visits, de？ nitions of hyperglycemic or hypoglycemic crisis were met, of which 180 episodes of diabetic ketoacidosis, 29 hyperosmolar hyperglycemic conditions, 359 hypoglycemic conditions, and 567 cases of newly diagnosed diabetes. The number of episodes of hyperglycemic crisis was been without major ？ uctuations over years. Only 17.72% of diabetic ketoacidosis cases were reported in patients with type 1 diabetes, whereas the remaining patients were diagnosed with type 2 diabetes. Infections were reported as the most common risk factor for diabetic ketoacidosis (35.4%), followed by missed insulin therapy as the second most common cause (29.3%). Repeated admission within 30 days was recorded in 15% of patients with acute complications of diabetes. Discussion: The frequency of visits of diabetic patients was higher than expected due to the frequency of diagnoses in the general population. There was an annual increase in the incidence of diabetic ketoacidosis and hypoglycemia in patients older than 60 years. Considering the guidelines for