The precise prevalence and incidence of HHS is difficult to determine because of the lack of population-based studies and the multiple comorbidities often found in these patients. However, the overall prevalence is estimated at less than 1% of all diabetes-related hospital admissions.[6]Pasquel FJ, Tsegka K, Wang H, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb;43(2):349-57.
https://care.diabetesjournals.org/content/43/2/349.long
http://www.ncbi.nlm.nih.gov/pubmed/31704689?tool=bestpractice.com
[15]Umpierrez GE, Kelly JP, Navarrete JE, et al. Hyperglycemic crises in urban Blacks. Arch Intern Med. 1997 Mar 24;157(6):669-75.
http://www.ncbi.nlm.nih.gov/pubmed/9080921?tool=bestpractice.com
[16]Kitabchi AE, Fisher JN, Murphy MB, et al. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. In: Kahn CR, Weir GC, eds. Joslin's diabetes mellitus. 13th ed. Philadelphia, PA: Lea and Febiger; 1994:738-70.
HHS is seen most commonly in older patients with poorly controlled type 2 diabetes.[3]Mustafa OG, Haq M, Dashora U, et al. Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for inpatient care group. Diabet Med. 2023 Mar;40(3):e15005.
https://onlinelibrary.wiley.com/doi/10.1111/dme.15005
http://www.ncbi.nlm.nih.gov/pubmed/36370077?tool=bestpractice.com
[4]Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2017 Dec 1;96(11):729-36.
https://www.aafp.org/afp/2017/1201/p729.html
http://www.ncbi.nlm.nih.gov/pubmed/29431405?tool=bestpractice.com
Mortality rates in HHS have been reported to be 5% to 20%, a rate that is 10-fold higher than that reported for diabetic ketoacidosis.[2]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-43.
http://care.diabetesjournals.org/content/32/7/1335.long
http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com
[3]Mustafa OG, Haq M, Dashora U, et al. Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for inpatient care group. Diabet Med. 2023 Mar;40(3):e15005.
https://onlinelibrary.wiley.com/doi/10.1111/dme.15005
http://www.ncbi.nlm.nih.gov/pubmed/36370077?tool=bestpractice.com
Mortality increases significantly when the patient is above the age of 70 years.[17]Wachtel TJ, Silliman RA, Lamberton P. Prognostic factors in the diabetic hyperosmolar state. J Am Geriatr Soc. 1987 Aug;35(8):737-41.
http://www.ncbi.nlm.nih.gov/pubmed/3611564?tool=bestpractice.com
A combined state of severe hyperglycemia, hyperosmolality, and metabolic acidosis is seen in approximately 24% to 33% of all hyperglycemic emergencies.[6]Pasquel FJ, Tsegka K, Wang H, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb;43(2):349-57.
https://care.diabetesjournals.org/content/43/2/349.long
http://www.ncbi.nlm.nih.gov/pubmed/31704689?tool=bestpractice.com
[18]Chung ST, Perue GG, Johnson A, et al. Predictors of hyperglycaemic crises and their associated mortality in Jamaica. Diabetes Res Clin Pract. 2006 Aug;73(2):184-90.
http://www.ncbi.nlm.nih.gov/pubmed/16458989?tool=bestpractice.com
[19]Magee MF, Bhatt BA. Management of decompensated diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Crit Care Clin. 2001 Jan;17(1):75-106.
http://www.ncbi.nlm.nih.gov/pubmed/11219236?tool=bestpractice.com