Epidemiology

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.[10][11] The incidence of HHS has been estimated at a rate of 17.5 per 100,000 patient years.[7]

HHS is seen most commonly in older patients and those of African-American ethnicity with diabetes.[11] 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.[1][12] Mortality increases significantly when the patient is above the age of 70 years.[13] A combined state of severe hyperglycemia, hyperosmolality, and metabolic acidosis is seen in approximately 25% of all hyperglycemic emergencies.[5][14][15]

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