Frequency and severity of ketoacidosis at diagnosis among childhood type 1 diabetes in Khartoum state, Sudan

Abstract

Background: Diabetic ketoacidosis (DKA) is a potentially life threatening acute complication of Type I diabetes mellitus (T1DM). This study aimed to determine the frequency and clinical characteristics of pediatric DKA at diagnosis of new-onset T1DM in Khartoum during 2000- 2017 period.
 Methods: The study was retrospective and involved review of medical files of children (<15 years) with T1DM in the city hos- pitals and diabetes centers.
 Results: The overall frequency of DKA among T1DM children at onset of disease diagnosis was 17.6% (173/982). The epi- sodes of DKA increased from 26% in first 6- year period (2000-2005) to 46.3% in the last 6-year period (2011-2012; p<0.001). No significant difference in the frequency of DKA was observed according to gender (p=0.9) and age (p=0.24). Compared to other age groups, the severity of DKA (pH<7.1) was higher in pre-school children (p<0.01). Approximately, 5% of patients were complicated with cerebral edema with a mortality rate of 1.7%.
 Conclusion: The DKA frequency at diagnosis of childhood T1DM in Khartoum was lower than previous reports. In addition, the severity of DKA was high among pre-school age children with a relatively high mortality rate when compared to the global rate.
 Keywords: Ketoacidosis; mortality; onset; DKA; T1DM; Sudan; Khartoum.

Frequency, Clinical Characteristics and Predictors of Ketoacidosis at Diagnosis of Type One Diabetes Mellitus in Children and Adolescents from Jordan

“…Studies from the Middle East region showed almost similar rates of DKA at onset of T1D ranging between 33.6% in Kuwait, 31% in Oman and 37.7% in Saudi Arabia ( 17 , 18 , 19 ). In Sudan, however, a recent study reported a DKA rate of 17.6% at diagnosis of T1D ( 20 ). This variation in the rates of DKA at diagnosis of T1D was also seen in developed countries ranging from 19.5% and 19.8% in Sweden and Germany to 41.2% and 43.8% in Italy and Luxembourg respectively ( 21 , 22 ).…”

Pediatric Diabetic Ketoacidosis (PDKA) among newly diagnosed diabetic patients at Dilla University Hospital, Dilla, Ethiopia: prevalence and predictors

“…This is much higher than the study conducted in Ethiopian capital, Addis Ababa (35.8%), which was 80% 15 years back( 7,17 ), but much lower than in northern part of Ethiopia, Tigray(78.7%)( 8 ).The high level literacy of the community and the availability of wide range of awareness creation methods(such as screening, posters, flyers and awareness campaigns) in the capital might explain the sharp decline in the incidence. The model was demonstrated in Germany, where the incidence was reduced from 28% to 16% through the Stuttgart ketoacidosis campaign, which focused on the symptoms of type 1 DM ( 10 ).In addition, the current prevalence is higher than that in other African countries such as Egypt(46%)( 15 ), Sudan(17.6%)( 18 ), and Tanzania(43%)( 19 ), but lower than that in two studies in Nigeria(100%)( 9 ) ( 77%)( 20 ).Outside the African continent, the reported prevalence was UK(25%)( 21 ), Germany(20%)( 22 ), Finland(19.4%)( 23 ), Sweden(16%), USA (30%), Canada (18.6%)( 16 ), Kuwait (35.9%), and China (50.1%)( 24 ), all showing wide geographic variation in its incidence. Various factors have been identified for a wide range of variations, including variations in the prevalence of diabetes, demonstrating an inverse relationship between type 1 diabetes mellitus prevalence and DKA incidence ( 25, 26 ).…”

The phenotype of type 1 diabetes in sub-Saharan Africa

“…Studies from SSA show that the reported DKA at diabetes diagnosis is highly variable, from 20 and 80% depending on the population studied (55,58,(80)(81)(82). For most of these studies, DKA has not been rigorously defined, with the diagnosis of DKA based on clinical presentation and urine ketones (83).…”