Frequency and Risk Factors of Diabetic Ketoacidosis in a Specialized Children’s Hospital, Riyadh: A Cross-sectional Study

Abstract

Objectives: Diabetic-ketoacidosis (DKA) is a life-threatening complication and a leading cause of hospitalization in Type-1-diabetes (T1DM) patients. We aimed to assess the risk factors of admissions of children with DKA in a specialized children hospital in order to reduce morbidity and to inform appropriate prevention and intervention strategies. Methods: A retrospective review of all DKA admissions at King Abdullah Specialized Children’s Hospital, Riyadh (March 2015–December 2017). Data were gathered from newly diagnosed of T1DM and known patients ≤14-year-old with DKA criteria. The main variables were frequency, precipitating factors, and other characteristics of DKA admissions in both groups. Results: A total of 116/562 patients with T1DM (mean age 8.97±3.08 years) had 146 DKA episodes, of which 26/116 (34%) were newly diagnosed. The frequency of DKA admissions 2 were 146/562, 26%, of which (n=42/146, 28.7%) were newly diagnosed vs. (n=104/146, 71.2%) known patient of T1DM. The majority were 10-14 years (p≤0.001) and 55.5% were females. Missing insulin was the main precipitating cause of DKA (p=0.001) among known patients with T1DM. Recurrent episodes (n=30/164, 20.5%) occurred in 15/116 patients and were more common in children ≥10 years of age (P=0.024). The mean length-of-stay was 2.67±2.04 days and increased with DKA severity (P=0.008). Conclusions: In our study, the majority of DKA episodes were in patients with known T1DM; and missing insulin was the leading cause of DKA. In addition to awareness campaigns to prevent DKA as an initial presentation, intervention strategies should also target high risk groups of known patients of T1DM such as adolescents and patients with recurrent episodes.

Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children

“…The causes leading to prolonged admission after DKA resolution were similar between groups. Similarly, previous studies have reported prolonged admission after DKA resolution . Future interventions are needed to reduce prolonged hospitalization after DKA resolution.…”

“…Third, our study reflects the perspective of a single health care system with a small number of patients, although the DKA treatment costs and LOS at our center were similar to those of most public health care institutions in Saudi Arabia. The median LOS for mild DKA in Saudi Arabia is 2 to 4 days, whereas in the US health care system it is 3.22 days . Moreover, the costs of different health care resources used in the management of DKA are not significantly different from those of other health care systems with universal health care, such as the UK public health care system .…”

“…Similarly, previous studies have reported prolonged admission after DKA resolution. [12][13][14][27][28][29] Future interventions are needed to reduce prolonged hospitalization after DKA resolution.…”

“…The median LOS for mild DKA in Saudi Arabia is 2 to 4 days, whereas in the US health care system it is 3.22 days. [27][28][29] Moreover, the costs of different health care resources used in the management of DKA are not significantly different from those of other health care systems with universal health care, such as the UK public health care system. 25 Future studies are needed to assess the generalizability of our findings to other market-based health care systems, such as the US health care system, in which DKA treatment is costly.…”

A Clinical and Biochemical Comparative Study Of Diabetic Ketoacidosis (DKA) in Newly Diagnosed Vs Known Cases of Type 1 Diabetic Children

“…Diabetic ketoacidosis (DKA) is an acute complication of type 1 DM that may lead to severe morbidity and a life-threatening state of the disease, which might happen the first clinical presentation of newly diagnosed Type 1 diabetic children or might happen for the known cases of Type diabetic children through there life as a consequence of different etiologies [ 3 , 4 ].The incidence of DKA in newly diagnosed Type diabetic children varies dramatically among countries from 13 to 80 % inversely correlated to the prevalence of Type 1 DM in that country, and it is less common in adolescents compared to young children [ 5 ]. In Saudi Arabia the incidence of DKA in newly diabetic children [ 6 , 7 ].…”