- βFirst UK multicenter system to track and compare HHS care quality across hospitals
- βIdentified older age and high sodium as key predictors of HHS mortality
- βDEKODE digital tool showed strong usability and potential to standardise national HHS guidelines
| Journal | BMJ open diabetes research & care |
| Year | 2025 |
| Authors | Kew, Manta, Sawlani |
| PMID | 41360624 |
What Was Studied and Why It Matters
Hyperosmolar hyperglycemic state β called HHS β is one of the most dangerous emergencies a person with diabetes can face. Blood sugar rises to extreme levels, the blood becomes dangerously thick, and without fast, correct treatment, the condition can be fatal. Despite this, the UK had no national system to track how hospitals were handling HHS cases or whether patients were receiving consistent, guideline-based care.
Researchers from 12 NHS hospitals set out to change that. Between 2021 and 2024, they built and tested a digital tracking system called DEKODE-HHS to monitor real-world HHS care, compare hospitals, and identify what was getting in the way of best practice.
What the Study Found
The research team reviewed 218 HHS episodes. Here is what stood out:
- Patients were typically older and very unwell: The average age was 77, and most had type 2 diabetes alongside other serious health conditions.
- Hospital stays were long: The median stay was over 10 days.
- The death rate was high: 16.1% of patients died β a stark reminder of how life-threatening HHS truly is.
- Care varied significantly between hospitals: How much insulin was given, how often blood sugar was checked, and when patients were discharged differed widely from one hospital to the next.
- Two factors predicted worse outcomes: Older age and higher sodium levels in the blood were independently linked to a greater risk of death.
Why Hospitals Weren't Following the Same Guidelines
The research team also interviewed hospital staff to understand barriers to consistent care. The most common problems included:
- HHS being misdiagnosed or confused with other conditions
- Stretched resources and staffing pressures
- Lack of familiarity with the specific guidelines for HHS management
On the positive side, once the DEKODE system was adopted, staff found it educational and easy to use β suggesting that better tools can genuinely improve care.
What This Means for Patients and Caregivers
If you or someone you care for has type 2 diabetes β especially at an older age β understanding HHS is important. Unlike diabetic ketoacidosis (DKA), HHS typically develops slowly over days. Warning signs include extreme thirst, very high blood sugars, confusion, and weakness. It requires emergency medical attention immediately.
This study also highlights the importance of consistent glucose monitoring at home. Keeping track of blood sugar trends can help catch dangerously rising levels before they become an emergency. At MDS Diabetes, we supply a full range of blood glucose monitors, test strips, and continuous glucose monitoring accessories to help you stay on top of your readings every day.
The DEKODE-HHS system is a promising step toward making HHS care more consistent across the UK, and its findings are expected to shape future national guidelines.
Bottom Line
HHS is a life-threatening diabetes emergency with a death rate above 16%, yet care quality varies dramatically between UK hospitals. A new digital tracking system has shown it is possible to monitor and improve HHS care nationally. For patients, the key takeaway is clear: regular glucose monitoring and knowing the warning signs of HHS can be lifesaving.