Diabetic ketoacidosis in Saudi Arabia: factors precipitating initial admission and readmission

Abstract

BACKGROUND: Diabetic ketoacidosis (DKA) is one of the complications of diabetes mellitus (DM), primarily type 1 DM. To our knowledge, only one study explored DKA readmission rates in Saudi Arabia. OBJECTIVES: Identify and analyze precipitating factors for DKA admission and readmission. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: We identified all patients aged 15 years and older admitted with DKA from 2018 to 2020. Descriptive factors and uni-and multivariate analyses are presented for associations with initial admission and readmission. MAIN OUTCOME MEASURES: Relationships between precipitating factors and initial admission and readmission. SAMPLE SIZE: 176 patients. RESULTS: Most of the patients had type 1 DM (n=157). The median (interquartile percentiles) for duration of DM was 6.0 (1.0-12.0) years. The mean (SD) HbA1C (%) was 11.8 (2.6). The factors that precipitated DKA were most commonly treatment nonadherence (55.1%), followed by infections (31.8%) and nonadherence to diet (25.6%). The most common symptoms were nausea and vomiting (87.5%), followed by abdominal pain (72.7%). During the study period, 32.4% of the sample were read-mitted with DKA. The median (interquartile range) duration between the first and second admission was 12 (4-25) weeks. In the multivariate analysis, increased odds of readmission for DKA were associated with type 1 DM and medication nonadherence ( P =.038, P =.013, respectively). The severity of the initial DKA and the control of DM were not associated with the readmission rate. CONCLUSION: Treatment nonadherence is the leading precipitating factor of DKA in our region. Patient education and counseling play a major role in addressing this preventable complication and its medical and financial burden. We advocate more efforts dedicated toward patient education and logistic support. LIMITATIONS: Retrospective-single center. CONFLICT OF INTEREST: None.

Socio-demographic and clinical characteristics of patients with diabetic ketoacidosis at King Salman bin Abdulaziz medical city in Al-Madinah, Saudi Arabia

“…Clinical manifestation among patients with diabetic ketoacidosis this study, we found the majority of study participants were younger than 40 years, participants' mean age was 35.6 and half of the patients were males which is nearly similar to other studies(Agarwal et al, 2016;Alotaibi et al, 2022). Most of the patients in our study were type 1 DM in line with previous studies(Agarwal et al., 2016; Alotaibi et al, 2022; Ndebele and Naidoo, 2018), Our study found that 8.5% of newly diagnosed patients with DM for the first time among patients admitted to the hospital with DKA which was lower than 16%-20% in previous studies (Almalki et al, 2016; Alotaibi et al, 2022; Iddi et al, 2017).…”

Clinical variables influencing the severity of diabetes ketoacidosis

“…Several researchers reported higher DKA episodes among patients of Saudi nationality with rates exceeding 50%. 23 , 27 In this particular study, it was noted that although the number of DKA episodes was slightly higher among Saudis, the severity of the episodes was more pronounced in non-Saudis.…”

Diabetic ketoacidosis: Knowledge and awareness assessment among parents and caregivers of children and adolescents diagnosed by Type l DM in Saudi Arabia

“…There are two forms of DM, type 1 diabetes mellitus, which is the absence of insulin due to loss of pancreatic β-cells by the immune process and (Diabetes-Mellitus) Type 2, characterized by insulin resistance (Caetano et al, 2022;Elhassan et al, 2022). Saudi Arabia ranks among higher countries with an incidence of DM (Alotaibi et al, 2022). A common complication in a patient with DM is DKA, which frequently occurs at the beginning of T1DM diagnosis due to inadequate adherence to insulin treatment (Rakshit, 2021).…”