Crafting a Publication Title for HHS Complications in Older Adults with Type 2 Diabetes
Your publication title should emphasize the high mortality risk and unique clinical presentation of hyperosmolar hyperglycemic state (HHS) in older adults, as this population faces substantially higher mortality rates and more severe complications compared to younger patients. 1
Recommended Title Structure
Core Elements to Include
Specify "Hyperosmolar Hyperglycemic State (HHS)" rather than generic "hyperglycemic crisis" to distinguish from diabetic ketoacidosis (DKA), as HHS has distinct pathophysiology and higher mortality rates 1
Emphasize the geriatric population explicitly, as older adults (≥65 years) with HHS have more than twice the mortality risk compared to younger patients and face unique complications including cognitive impairment, falls, and functional decline 1
Highlight specific complications such as cerebral edema, central pontine myelinolysis, thrombotic events, or mortality outcomes, as these represent the most clinically significant morbidity and mortality endpoints 1, 2, 3
Suggested Title Formats
Option 1 (Mortality-Focused): "Mortality and Neurological Complications of Hyperosmolar Hyperglycemic State in Older Adults with Type 2 Diabetes: A [Study Type] Analysis"
Option 2 (Complication-Specific): "Central Pontine Myelinolysis and Cerebral Edema in Elderly Patients with Hyperosmolar Hyperglycemic State: Risk Factors and Outcomes"
Option 3 (Population-Focused): "Hyperosmolar Hyperglycemic State in Geriatric Type 2 Diabetes: Complications, Mortality, and Management Challenges"
Critical Terminology Considerations
Use "Hyperosmolar Hyperglycemic State (HHS)" Not "Non-Ketotic"
The term "non-ketotic" is outdated and imprecise, as approximately 10% of HHS cases present with mixed DKA-HHS features with some ketonemia 1, 2
Modern diagnostic criteria define HHS by osmolality ≥320 mOsm/kg, glucose ≥30 mmol/L (≥540 mg/dL), pH >7.3, and bicarbonate ≥15 mmol/L, without requiring complete absence of ketones 2, 3
Specify "Older Adults" or "Geriatric" Rather Than Generic Terms
Older adults represent a clinically distinct population with higher baseline comorbidities, polypharmacy, cognitive impairment, and functional limitations that substantially increase HHS mortality 1
This population requires different treatment approaches, including more cautious fluid resuscitation (fluid losses 100-220 mL/kg must be replaced carefully to avoid fluid overload in elderly patients with cardiac/renal compromise) 1, 2
Complications to Emphasize Based on Clinical Impact
Highest Mortality/Morbidity Complications
Neurological complications carry the highest morbidity risk and should be prioritized in your title:
- Central pontine myelinolysis occurs with rapid osmolality correction (>8 mOsm/kg/h decline) and causes permanent neurological damage 2, 3
- Cerebral edema, though rare, is potentially fatal and more common in elderly patients 1, 4
- Seizures occur in up to 25% of HHS cases and indicate severe osmotic disturbances 2, 5
Cardiovascular complications represent the leading cause of death:
- Myocardial infarction and stroke are common precipitants and complications of HHS 2, 3
- Thrombotic events including deep vein thrombosis and pulmonary embolism occur due to severe hyperosmolality and dehydration 2
Mortality rates are substantially higher in HHS than DKA:
- Overall HHS mortality ranges from 10-20%, compared to <1% for DKA 2, 3
- Elderly patients have even higher mortality, particularly those with euglycemic hyperosmolar hypernatremic state (a variant with glucose <600 mg/dL but osmolality >320 mOsm/kg), which carries 35% mortality 6
Common Pitfall to Avoid
Do not use "hyperosmolar non-ketotic coma" in your title, as this outdated term incorrectly implies all patients present in coma (only 25-50% have altered mental status severe enough to qualify as coma), and the "non-ketotic" designation is imprecise given mixed presentations 1, 2, 3
Additional Title Considerations
If Focusing on Management Complications
Emphasize iatrogenic complications from overly aggressive treatment, particularly rapid osmolality correction leading to central pontine myelinolysis (aim for 3-8 mOsm/kg/h decline) 2, 3
Highlight fluid overload complications in elderly patients with cardiac/renal disease who require careful monitoring during the 100-220 mL/kg fluid replacement 2
If Focusing on Diagnostic Challenges
Consider emphasizing the euglycemic hyperosmolar hypernatremic state variant, which has 35% mortality but may be missed due to glucose <600 mg/dL 6
Highlight mixed DKA-HHS presentations, which occur in approximately 10% of cases and require modified treatment approaches 1, 2