Mapping the storm: a scoping review of diabetic emergencies in Africa

Abstract

Objective This scoping review aimed to map the evidence on the patterns and burden of diabetic emergencies among people with diabetes in Africa. Methods The review followed the Levac et al. framework and the PRISMA-ScR guidelines. A systematic search was conducted across five electronic databases (CINAHL, Embase, MEDLINE, Scopus, and Web of Science), and manual searches in Google and Google Scholar were conducted for studies published between 2015 and 2025. From 1,207 records, 25 studies met the inclusion criteria. Extracted data were analyzed using thematic analysis and descriptive numerical summaries. Findings Of the 25 reviewed studies, diabetic ketoacidosis (DKA) was the most commonly reported emergency, appearing in 17 studies, with proportions ranging from 2.0% to 92.6%. This was followed by hyperosmolar hyperglycemic state (HHS), reported in 11 studies (4.5%–50.6%), and hypoglycemia, reported in 9 studies (0.8%–28.3%). Common determinants included infections and intercurrent illness, poor glycemic control, treatment non-adherence or discontinuation, and limited access to ongoing care. Reported in-hospital mortality ranged from 5% to 17.1%, with DKA case fatality reaching 30% in some studies. Median hospital stay generally ranged from 6 to 9 days. Conclusion Diabetic emergencies are a major, yet largely preventable, cause of illness and death among people with diabetes in Africa. Conditions such as DKA place a heavy strain on African healthcare systems. To reduce the rates of these avoidable complications, it is essential to improve primary care for early detection and ensure consistent access to insulin and glucose monitoring.