Diabetic Hyperosmolar Hyperglycemic Syndrome: Who Is Most At Risk?

Diabetic hyperosmolar hyperglycemic syndrome (HHS) is a serious acute complication of diabetes that most commonly affects older adults, particularly those over the age of 75. This age group often experiences a natural decline in cognitive function, which can reduce their sensitivity to early signs of infection or dehydration. As a result, these conditions may progress unnoticed, eventually triggering a cascade that leads to severe hyperglycemia and hyperosmolarity.

Why Older Adults Are More Vulnerable

One of the key reasons HHS is more prevalent in elderly patients is their diminished ability to recognize symptoms such as excessive thirst, confusion, or fatigue. This lack of awareness delays medical intervention, allowing blood glucose levels to rise dangerously high—often beyond 30 mmol/L—without obvious symptoms. In contrast, younger individuals typically have more responsive organ systems and are more likely to notice and report early warning signs, allowing for timely treatment.

Comparing Risk Factors in Different Age Groups

Younger diabetic patients are generally more attuned to changes in their body. Their bodies react more quickly to high blood sugar levels, dehydration, or infection, which makes it easier to detect and manage issues before they escalate into HHS. However, in older adults, especially those with long-standing diabetes or other comorbidities, these protective mechanisms may be impaired, increasing the risk of developing this life-threatening condition.

High Mortality and Importance of Early Detection

Due to the subtle and often non-specific symptoms in elderly patients, HHS can go undiagnosed until it reaches a critical stage. As a result, the mortality rate associated with HHS is significantly higher than that of diabetic ketoacidosis (DKA), another serious diabetic complication. Prompt recognition and medical care are essential to improving outcomes, especially among older individuals who may not display typical symptoms of hyperglycemia.

Understanding the risk factors and being vigilant about subtle changes in health status—particularly in elderly diabetic patients—can make a crucial difference in preventing the progression of this dangerous syndrome.