Managing patients with Diabetes Mellitus after a cholera attack: A retrospective analysis in a tertiary center and specialty clinic in Sana’a Yemen

Abstract

Objective: We aimed to investigate patients with diabetes mellitus who presented for management of their diabetes after developing cholera during the cholera epidemic in Yemen. Patients and methods: This is a retrospective chart review of all patients with the diagnosis of Diabetes Mellitus (DM) who presented after an attack of cholera from June 2018-June 2019 in 2 clinics (endocrinology and nephrology) in the University of Science and Technology hospital in Sana’a Yemen and a private endocrinology clinic. Also, 120 charts were reviewed as a control group on patients with diabetes mellitus with no history of cholera. Result: A total of148 charts were reviewed, 28 patients with diabetes mellitus who presented within 2 months of developing cholera and 120 patients with diabetes mellitus but no history of cholera who served as the control group. The mean age of the patients with a history of cholera was 54.8 (SD 14.7) and in the control group was 52.4 (SD 17.4). In the 21 patients with cholera that were on oral hypoglycemic agents (OHA) or no medications before the attack, 66.7% (N=14) required insulin after developing cholera. In comparison to the control group, 54.2% (N=65) patients were on OHA or no medications at presentation and none of these patients were started on insulin at the initial visit (p-value <0.001). In those patients who had been switched to insulin in the cholera group 78.5% (N=11) of them still required insulin months after developing cholera and only 21.5% (N=3) were able to switch back to OHA. Among the 7 patients on insulin before the attack, 85% (N=6) of them required an increase in the dose of insulin. Conclusion: The majority of patients who presented to us after developing cholera required insulin and those already on insulin required an increase in their dose. Physicians caring for cholera patients should be aware of this and if not able to manage while the patient is being rehydrated should advise the patient to seek medical attention for management of their diabetes after rehydration if having hyperglycemia.