{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:32:28Z","timestamp":1790400748899,"version":"4.1.0"},"reference-count":37,"publisher":"American Diabetes Association","issue":"2","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"Bispebjerg and Frederiksberg Hospital, Department of Emergency Medicine"},{"name":"Bispebjerg and Frederiksberg Hospital Research Committee Fund"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>The hyperosmolar hyperglycemic state (HHS) is a rare and life-threatening complication of diabetes. We aimed to estimate the incidence of HHS and describe the clinical and biomarker profiles of patients with HHS, including subgroups with acidosis and acute kidney injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>This nationwide, descriptive cohort study used Danish registry data during years 2016\u20132018 to identify acutely admitted patients fulfilling the hyperglycemia and hyperosmolarity criteria of HHS (glucose \u226533 mmol\/L and osmolarity [2 \u00d7 sodium + glucose] \u2265320 mmol\/L).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>We identified 634 patients (median age, 69 years (first quartile; third quartile: 58; 79) who met the criteria of HHS among 4.80 million inhabitants aged \u226518 years. The incidence rates were 16.5 and 3.9 per 10,000 person-years among people with known type 1 (n = 24,196) and type 2 (n = 251,357) diabetes, respectively. Thirty-two percent of patients with HHS were not previously diagnosed with diabetes. Patients were categorized as pure HHS (n = 394) and combined HHS and diabetic ketoacidosis (HHS-DKA; n = 240). The in-hospital mortality rate for pure HHS was 17% and 9% for HHS-DKA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The incidence of HHS was higher among patients with type 1 diabetes compared with type 2 diabetes. HHS is a spectrum of hyperglycemic crises and can be divided in pure HHS and HHS-DKA. In one-third of patients, HHS was the debut of their diabetes diagnosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc23-0988","type":"journal-article","created":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T18:14:41Z","timestamp":1702404881000},"page":"272-279","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":15,"title":["Incidence and Characteristics of the Hyperosmolar Hyperglycemic State: A Danish Cohort Study"],"prefix":"10.2337","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7436-2253","authenticated-orcid":false,"given":"Emilie V.","family":"Rosager","sequence":"first","affiliation":[{"name":"1Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia L\u00e6rke K.","family":"Helt\u00f8","sequence":"additional","affiliation":[{"name":"1Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathrine U.","family":"Fox Maule","sequence":"additional","affiliation":[{"name":"2Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennart","family":"Friis-Hansen","sequence":"additional","affiliation":[{"name":"3Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"},{"name":"4Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janne","family":"Petersen","sequence":"additional","affiliation":[{"name":"2Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"},{"name":"5Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn E.","family":"Nielsen","sequence":"additional","affiliation":[{"name":"1Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steen B.","family":"Haugaard","sequence":"additional","affiliation":[{"name":"4Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"},{"name":"6Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9439-4933","authenticated-orcid":false,"given":"Rasmus","family":"Gregersen","sequence":"additional","affiliation":[{"name":"1Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"},{"name":"2Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark"},{"name":"5Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"2024011919581144000_B1","doi-asserted-by":"crossref","first-page":"l1114","DOI":"10.1136\/bmj.l1114","article-title":"Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients","volume":"365","author":"Karslioglu French","year":"2019","journal-title":"BMJ"},{"key":"2024011919581144000_B2","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2337\/diacare.24.1.131","article-title":"Management of hyperglycemic crises in patients with diabetes","volume":"24","author":"Kitabchi","year":"2001","journal-title":"Diabetes Care"},{"key":"2024011919581144000_B3","doi-asserted-by":"crossref","first-page":"e15005","DOI":"10.1111\/dme.15005","article-title":"Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group","volume":"40","author":"Mustafa","year":"2023","journal-title":"Diabet Med"},{"key":"2024011919581144000_B4","doi-asserted-by":"crossref","first-page":"3124","DOI":"10.2337\/dc14-0984","article-title":"Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment","volume":"37","author":"Pasquel","year":"2014","journal-title":"Diabetes Care"},{"key":"2024011919581144000_B5","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/dme.12757","article-title":"Management of hyperosmolar hyperglycaemic state in adults with diabetes","volume":"32","author":"Joint British Diabetes Societies (JBDS) for Inpatient Care","year":"2015","journal-title":"Diabet Med"},{"key":"2024011919581144000_B6","unstructured":"Almdal\n              T\n            , JuhlC, KielgastU, . 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Laboratory reference levels\n          . Accessed 19 September 2023. Available from https:\/\/www.sundhed.dk\/sundhedsfaglig\/laegehaandbogen\/undersoegelser-og-proever\/klinisk-biokemi\/blodproever\/"},{"key":"2024011919581144000_B29","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1001\/archinte.1997.00440270117011","article-title":"Hyperglycemic crises in urban blacks","volume":"157","author":"Umpierrez","year":"1997","journal-title":"Arch Intern Med"},{"key":"2024011919581144000_B30","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2337\/dc19-2449","article-title":"Trends in emergency department visits and inpatient admissions for hyperglycemic crises in adults with diabetes in the U.S., 2006-2015","volume":"43","author":"Benoit","year":"2020","journal-title":"Diabetes Care"},{"key":"2024011919581144000_B31","doi-asserted-by":"crossref","first-page":"729","DOI":"10.2169\/internalmedicine.49.2965","article-title":"Short-term case fatality rate and associated factors among inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state: a hospital-based analysis over a 15-year period","volume":"49","author":"Chen","year":"2010","journal-title":"Intern Med"},{"key":"2024011919581144000_B32","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0002-9343(99)00055-8","article-title":"Hyponatremia: evaluating the correction factor for hyperglycemia","volume":"106","author":"Hillier","year":"1999","journal-title":"Am J Med"},{"key":"2024011919581144000_B33","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1056\/NEJM200005253422107","article-title":"Hyponatremia","volume":"342","author":"Adrogu\u00e9","year":"2000","journal-title":"N Engl J Med"},{"key":"2024011919581144000_B34","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1055\/s-0043-117416","article-title":"The impact of hyperosmolarity on long-term outcome in patients presenting with severe hyperglycemic crisis: a population based study","volume":"126","author":"Kruljac","year":"2018","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"2024011919581144000_B35","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1002\/dmrr.2486","article-title":"Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment","volume":"30","author":"Hwang","year":"2014","journal-title":"Diabetes Metab Res Rev"},{"key":"2024011919581144000_B36","doi-asserted-by":"crossref","first-page":"180","DOI":"10.3803\/EnM.2017.32.2.180","article-title":"Glucocorticoid-induced diabetes mellitus: an important but overlooked problem","volume":"32","author":"Suh","year":"2017","journal-title":"Endocrinol Metab (Seoul)"},{"key":"2024011919581144000_B37","doi-asserted-by":"crossref","first-page":"102313","DOI":"10.1016\/j.dsx.2021.102313","article-title":"Hyperosmolar diabetic ketoacidosis-- review of literature and the shifting paradigm in evaluation and management","volume":"15","author":"Brar","year":"2021","journal-title":"Diabetes Metab Syndr"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/doi\/10.2337\/dc23-0988\/745777\/dc230988.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/doi\/10.2337\/dc23-0988\/745777\/dc230988.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T19:59:08Z","timestamp":1705694348000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/47\/2\/272\/153983\/Incidence-and-Characteristics-of-the-Hyperosmolar"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,12]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,12,12]]},"published-print":{"date-parts":[[2024,2,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc23-0988","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,12]]}}}