- โFirst UK-wide surveillance system for HHS creates a foundation for improving national care standards
- โIdentified that older age and high sodium levels predict worse outcomes, helping doctors spot high-risk patients earlier
- โThe DEKODE digital tool proved practical and well-received by hospital staff, making it scalable across the NHS
| Journal | BMJ open diabetes research & care |
| Year | 2025 |
| PMID | 41360624 |
What Is This Research About?
Hyperosmolar Hyperglycemic State (HHS) is a serious, life-threatening emergency that can affect people with diabetes, particularly those with type 2 diabetes. It causes dangerously high blood sugar and dehydration. Researchers in the UK wanted to understand how well hospitals are treating this condition and whether care is consistent across different hospitals.
What Did the Researchers Do?
Between 2021 and 2024, researchers studied 218 cases of HHS across 12 NHS hospitals. They collected data on patient details, blood test results, treatments given, and outcomes. They also interviewed hospital staff to understand what made it easy or difficult to follow official guidelines. This was called the DEKODE-HHS model โ a digital tracking and quality improvement system.
Who Were the Patients?
- The average patient age was 77 years old
- 84.4% had type 2 diabetes
- Most patients had multiple other health conditions alongside diabetes
Key Findings
The study revealed some concerning patterns:
- The death rate was 16.1% โ meaning roughly 1 in 6 patients with HHS did not survive their hospital stay
- The average hospital stay was over 10 days
- There were major differences between hospitals in how insulin was dosed, how blood sugar was monitored, and when patients were discharged
- Older age and high sodium levels in the blood were the strongest predictors of who was most at risk of dying
Why Do These Differences Matter?
When hospitals treat the same condition very differently, some patients may receive care that doesn't match recommended guidelines. This variation could mean some patients receive less effective treatment, increasing their risk of serious harm or death. Standardising care could save lives.
What Were the Barriers to Better Care?
Hospital staff identified several challenges:
- Misdiagnosis โ HHS is sometimes confused with other conditions, delaying proper treatment
- Limited resources โ staffing and time pressures made it hard to follow detailed guidelines
- Lack of awareness โ some staff were not fully familiar with current HHS guidelines
What Is the DEKODE-HHS Model?
The DEKODE (Digital Evaluation of Ketosis and Other Diabetes Emergencies) system is a digital tool designed to help hospitals track how well they are managing diabetes emergencies like HHS. This study shows it is practical to use, well-received by staff, and has real potential to improve care quality across the UK.
What Does This Mean for Diabetes Patients?
If you or a loved one has type 2 diabetes โ especially if you are older โ it is important to know the warning signs of HHS. These include extreme thirst, confusion, very high blood sugar, and severe dehydration. HHS requires emergency hospital treatment. This research highlights the need for faster, more consistent care and better national monitoring systems to protect patients.
Bottom Line
This is the first UK-wide surveillance system for HHS, and it has already revealed important gaps in care. The researchers hope their findings will lead to updated national guidelines and more consistent, life-saving treatment for this dangerous diabetes emergency.