Endocrine Abstracts

Introduction: Hyperosmolar hyperglycaemic state (HHS) is an acute complication of diabetes which requires prompt recognition to prevent morbidity and death. Owing to its low prevalence, clinicians report a lack of confidence in management, which may result in delayed diagnosis and worsened outcomes. The limited literature on HHS management means most guidelines are based solely on expert opinion, resulting in significant discrepancies between care in centres.

Aim: s: This study aimed to establish a registry of HHS cases in order to identify baseline HHS management, share best practices across hospitals and highlight areas for improvement.

Methods: The study retrospectively analysed patients with HHS from March 2021 to January 2023 across eight hospitals within the West Midlands. Cases were identified from patient notes using criteria from the Joint British Diabetes Societies (JBDS) HHS guidelines¹: serum osmolality>320 mOsmol/kg and glucose>25 mmol/l. Osmolality was calculated using the formula [(2× sodium) + (2× potassium) + glucose + urea]. HHS resolution was documented as the earliest event of either serum osmolality falling below 300 mOsmol/kg, when fixed rate intravenous insulin infusion (FRIII) was stopped or when the team documented HHS resolution in the clinical notes. Patient demographics, precipitating cause of HHS and management regime were also collected. Data was analysed using SPSS and results presented as frequencies, median and interquartile range (IQR).

Results: 68 cases of HHS were identified. 73.5% had the correct diagosis documented and just 42.6% had serum osmolality measured during stay. The most common causes of HHS were intercurrent illness (48.5%), sepsis (16.2%) and new diagnosis of diabetes (13.2%). Median serum osmolality at diagnosis was 352 mOsmol/kg (IQR: 334.63-375.07) and patients recieved a median of 6750 ml fluid (IQR: 4000-10500) until HHS resolution. 27.9% had FRIII commenced within the first hour of diagnosis and 51.8% were also given basal insulin. While the length of stay was similar for HHS across included hospitals, there was a significant difference in HHS duration between sites (P<0.001).

Conclusion: These results suggest there is a need to improve awareness of HHS and the guidelines for its management amongst clinicians. By establishing a registry of HHS cases over several hospital trusts, best practices can be shared between healthcare professionals. Expanding the scope of this project to include other regions will allow uniform clinical care to be provided to HHS patients nationally.

Reference: 1. Joint British Diabetes Societies for inpatient care. The Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults [February 2022].