Cilj rada: Šećerna bolest je veliki zdravstveni i socioekonomski problem u Republici Hrvatskoj. Prema podatcima Hrvatskog zavoda za javno zdravstvo registrirano je preko 300.000 bolesnika sa šećernom bolesti, uz daljnji rast broja oboljelih. U 2017. godini šećerna bolest nalazila se na petom mjestu vodećih uzroka smrti sa 3,7 % udjela u ukupnoj smrtnosti. Dijabetička ketoacidoza, hiperglikemijsko hiperosmolarno stanje i hipoglikemija su ozbiljne komplikacije šećerne bolesti tip 1 i tip 2, koje su ujedno i najčešća hitna stanja u endokrinologiji. Iako se dijabetička ketoacidoza najčešće javlja u osoba s tipom 1 šećerne bolesti, a hiperosmolarno stanje s tipom 2 sve je veća pojavnost dijabetičke ketoacidoze i u dijabetičara s tipom 2 šećerne bolesti. Glavni cilj istraživanja je analizirati hipoglikemijske i hiperglikemijske krize bolesnika u hitnoj medicinskoj službi u razdoblju od 2010. do 2018. godine u Kliničkoj bolnici Sveti Duh. Metode: Ispitivana populacija obuhvaćala je ukupno 175.446 odrasle osobe pregledane u hitnoj medicinskoj službi u razdoblju od 1. 1. 2010. do 31. 12. 2018., uz vrijednost glukoze u plazmi većoj od 13,9 mmol/L ili manjoj od 3,9 mmol/L. Ovisno o nalazu acidobaznog statusa, ketonuriji i osmolarnosti plazme bolesnici su podijeljeni u jednu od četiri skupine: neketotična hiperglikemija, hipoglikemija u šećernoj bolesti, dijabetička ketoacidoza ili hiperosmolarno hiperglikemijsko stanje. Bolesnici su također podijeljeni prema dobi i tipu šećerne bolesti. Rezultati: U 3.773 posjeta bila je zadovoljena defi nicija hiperglikemijske ili hipoglikemijske krize, od čega 180 epizoda dijabetičke ketoacidoze, 29 hiperosmolarna hiperglikemijska stanja, 359 hipoglikemijska stanja te 567 slučajeva novootkrivene šećerne bolesti. Broj epizoda hiperglikemijskih kriza bio je tijekom godina bez većih odstupanja. Samo 17,72 % slučajeva dijabetičke ketoacidoze zabilježeno je u bolesnika sa šećernom bolesti tip 1, dok su preostali bolesnici imali dijagnozu tip 2. Zabilježeno je da su infekcije bile najčešći čimbenik rizika dijabetičke ketoacidoze s 35,4 %, propuštanjem terapije inzulina kao drugim najčešćim uzrokom s 29,3 %. U 15 % bolesnika s akutnim komplikacijama šećerne bolesti zabilježen je ponovni prijam u razdoblju od 30 dana. Rasprava: Učestalost posjeta hitnom prijmu bolesnika sa šećernom bolesti bila je veća od očekivane s obzirom na učestalost dijagnoze u općoj populaciji. Zabilježeno je godišnje povećanje broja slučajeva dijabetičke ketoacidoze i hipoglikemija u bolesnika sa šećernom bolesti starijih od 60 godina. S obzirom na smjernice kliničke prakse, vrijeme započinjanja i volumen primjene kristaloidnih otopina bili su u preko dvije trećine slučajeva zadovoljavajući. Međutim, usporedbom sa smjernicama kliničke prakse o primjeni inzulina unutar prvih 60 minuta, u više od dvije trećine slučajeva dijabetičke ketoacidoze vrijeme prve primjene bilo je nakon 100 minuta. Mogući razlozi su nespecifi čnost kliničkih znakova i vrijeme potrebno do dostupnosti rezultata krvnih nalaza. Zaključak: Učestalost šećerne bolesti u bolesnika koji su zaprimljeni u hitnu medicinsku službu veća je od očekivane u općoj populaciji uz porast broja bolesnika sa šećernom bolesti tip 1 i tip 2. Većina bolesnika s dijabetičkom ketoacidozom imala su šećernu bolest tip 2, iako su se bolesnici s tipom 1 u hitnoj službi češće prezentirali s dijabetičkom ketoacidozom. Najčešći prepoznati čimbenici rizika za dijabetičku ketoacidozu bile su infekcije i neodgovarajuća terapija inzulina. Zabilježen je porast korištenja metformina i DPP-4 inhibitora u terapiji šećerne bolesti.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 fi 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, defi 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 fl 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 clinical practice, the starting time and volume of crystalloid solutions administered were satisfactory in more than two-thirds of cases. However, compared to clinical practice guidelines for insulin administration within the fi rst 60 minutes, the time of fi rst administration was after 100 minutes in more than two-thirds of diabetic ketoacidosis cases. The possible reasons were non-specifi city of the clinical signs and the time it took for blood test result reporting. Conclusion: The incidence of diabetes in patients admitted to the emergency department was higher than expected in the general population, with an increase in type 1 and type 2 diabetes patients. Most patients with diabetic ketoacidosis had already been diagnosed with type 2 diabetes, although patients with type 1 diabetes more often presented with diabetic ketoacidosis to the emergency department. The most commonly recognized risk factors for diabetic ketoacidosis were infection and inadequate insulin therapy. There was an increase in the use of metformin and DPP-4 inhibitors in diabetes therapy
