KLINIK FOR DIABETES U N D STOFFWECHSELKRANK_HEITEN, STXDTISCHES KRANKENHAUS BERLIN-KAULSDORF ZENTRALSTELLE FOR DIABETES U N D STOFFWECHSELKRANKHEITEN, BERLIN/GDR
ADVANTAGE IN MANAGEMENT OF DIABETIC C O M A BY INTENSIVE CARE PETER SINGER
ANNELIESE RAHN
VOLKER SCHLIACK
The introduction of insulin therapy has markedly improved the prognosis of diabetic coma. The frequency dropped from above 60% in the pre-insulin era 2a to 0.20.3% of the diabetic population in the GDR as shown by prospective epidemiological studies in the conditions of a closely knit and comprehensive dispensary system a,. a2. Conditionally comparable data show the lethality of diabetic coma in this country to amount to about 40% even in clinics with considerable experiences in coma treatment (tab. 1). The total death rate from 1960 to the end of 1973 was 30% of our 763 patients with diabetic coma, being comparatively low due to the advantage of a centre where nearly all coma cases of the capital are being cared for ~' 40. In institutions without special experiences in treatment, the death rate of diabetic coma appears to exceed 50%. The difficulty in comparing results is a consequence of the variable deftnitions of diabetic coma and of the interval after which we still speak o f coma death, as well as of different diagnostic and therapeutic criteria. The term 'diabetic coma' relates to the stage of unconsciousness and differs from that of ketoaddosis preferred by several authors s. 11. la. Consequently, the apparently lower lethality of ketoacidosis found by several authors s, u. la. 24.42 cannot be used for comparison. In order to avoid errors of interpretation only the actual death rates found in this country will be summarized (tab. 1 ), The purpose of the present paper is to evaluate to what extent lethality may be influenced by intensive care under otherwise unchanged conditions in one and the same clinic. MATERIAL A N D M E T H O D S In 1972/73 the necessity of improving the survival of patients with diabetic coma has led to the establishment of an intensive care unit in our clinic. The unit has 8 beds and provisions for further enlargement. It is fitted with electronic equipment for ECG, Key-words: Cerebral edema; Diabetic coma; Intensive care; Lethality; Therapy. Received: July 8, 1976. Acta diabet. Iat. 14, 156, 1977.
156
P. SINGER, A. RAHN, V. SCHLIACK
Ries 37
Leipzig
1969
50?8
Semmler and Lemke 39
Potsdam
1969
41,°6
Fehlinger ~
Rostock
1970
519#o
P e t e et al. 34
Erfurt
1971
46,%
Panzram 3t, a2
E~furt
1973
32~
Table 1
-
Death rates in diabetic coma, comparable with reservation.
EEG and central venous pressure and offers the possibility for numerous measures of intensive therapy. About 80 to 100 coma patients were treated yearly in addition to severe complications like uremia, infarction and stroke. The parameters characterizing the patients and the diagnosis of coma were the same throughout the 14-years' period. Diabetic coma was diagnosed if various degrees of unconsciousness, blood sugar above 500 rag/100 ml, base excess (BE) below - 1 0 , pH < 7.36, blood acetone above 20 mg/100 ml were found ~. Comparison was made between the periods 1960-1964 and 1970-1973. Statistical analyses were performed using the X2 test.
RESULTS The statistical comparison of the two periods with an interval of 10 years (1960-1964 to 1970-1973) showed a decrease in overall lethality * from 34% (43 of 127 cases) in 1960-1964 to 2 8 3 (90 of 321 cases) in i970-1973. After
p
ADVANTAGE IN MANAGEMENT OF DIABETIC C O M A BY INTENSIVE CARE PETER SINGER
ANNELIESE RAHN
VOLKER SCHLIACK
The introduction of insulin therapy has markedly improved the prognosis of diabetic coma. The frequency dropped from above 60% in the pre-insulin era 2a to 0.20.3% of the diabetic population in the GDR as shown by prospective epidemiological studies in the conditions of a closely knit and comprehensive dispensary system a,. a2. Conditionally comparable data show the lethality of diabetic coma in this country to amount to about 40% even in clinics with considerable experiences in coma treatment (tab. 1). The total death rate from 1960 to the end of 1973 was 30% of our 763 patients with diabetic coma, being comparatively low due to the advantage of a centre where nearly all coma cases of the capital are being cared for ~' 40. In institutions without special experiences in treatment, the death rate of diabetic coma appears to exceed 50%. The difficulty in comparing results is a consequence of the variable deftnitions of diabetic coma and of the interval after which we still speak o f coma death, as well as of different diagnostic and therapeutic criteria. The term 'diabetic coma' relates to the stage of unconsciousness and differs from that of ketoaddosis preferred by several authors s. 11. la. Consequently, the apparently lower lethality of ketoacidosis found by several authors s, u. la. 24.42 cannot be used for comparison. In order to avoid errors of interpretation only the actual death rates found in this country will be summarized (tab. 1 ), The purpose of the present paper is to evaluate to what extent lethality may be influenced by intensive care under otherwise unchanged conditions in one and the same clinic. MATERIAL A N D M E T H O D S In 1972/73 the necessity of improving the survival of patients with diabetic coma has led to the establishment of an intensive care unit in our clinic. The unit has 8 beds and provisions for further enlargement. It is fitted with electronic equipment for ECG, Key-words: Cerebral edema; Diabetic coma; Intensive care; Lethality; Therapy. Received: July 8, 1976. Acta diabet. Iat. 14, 156, 1977.
156
P. SINGER, A. RAHN, V. SCHLIACK
Ries 37
Leipzig
1969
50?8
Semmler and Lemke 39
Potsdam
1969
41,°6
Fehlinger ~
Rostock
1970
519#o
P e t e et al. 34
Erfurt
1971
46,%
Panzram 3t, a2
E~furt
1973
32~
Table 1
-
Death rates in diabetic coma, comparable with reservation.
EEG and central venous pressure and offers the possibility for numerous measures of intensive therapy. About 80 to 100 coma patients were treated yearly in addition to severe complications like uremia, infarction and stroke. The parameters characterizing the patients and the diagnosis of coma were the same throughout the 14-years' period. Diabetic coma was diagnosed if various degrees of unconsciousness, blood sugar above 500 rag/100 ml, base excess (BE) below - 1 0 , pH < 7.36, blood acetone above 20 mg/100 ml were found ~. Comparison was made between the periods 1960-1964 and 1970-1973. Statistical analyses were performed using the X2 test.
RESULTS The statistical comparison of the two periods with an interval of 10 years (1960-1964 to 1970-1973) showed a decrease in overall lethality * from 34% (43 of 127 cases) in 1960-1964 to 2 8 3 (90 of 321 cases) in i970-1973. After
p
