Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia

Kidie, Atitegeb Abera; Lakew, Ayenew Molla; Ayele, Tiruneh

doi:10.2147/dmso.s326537

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…9 Ninety percent of child with DKA patients presents with polydipsia and polyuria, 77% presents with fatigue, 50% with polyphagia and few presents with fast breathing, Kussmaul breathing, abdominal pain, fever, and headache. 10 Unlike the common symptoms as above, our patient presented with fast breathing, lethargy, runny nose, cough, and which were simply suggestive of any kind of respiratory illness especially in patient of similar age group. However, laboratory reports were suggestive of severe DKA with new-onset diabetes.…”

Section: Discussionmentioning

confidence: 51%

New-onset severe Diabetic Ketoacidosis in a 13-months old Nepali Toddler: a case report

Basnet,

Bhattarai,

Bhatt

et al. 2023

Nep. Med. Coll. J.

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Diabetes mellitus (DM) is a glucose metabolism disorder with diabetic ketoacidosis (DKA) being the most common complication associated with significant morbidity and mortality. Unlike other patients with typical symptoms of abdominal discomfort, pain, nausea and emesis of DKA, our patient presented with atypical symptoms such as cough, runny nose and fast breathing. This symptoms would have initially misled with diagnosis of respiratory tract infection, which would have caused delay in the treatment of DKA. In our patient DKA was treated with intravenous fluid replacement followed by intravenous insulin infusion, along with monitoring of blood glucose and electrolyte levels. We would like to emphasize that DKA can be precipitated by simple upper respiratory tract infection in toddlers with undiagnosed type 1 DM. Hence, random blood sugar measurement and urine for ketone bodies test should be performed if feasible in sick patients presenting with respiratory tract illness-like symptoms.

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Section: Discussionmentioning

confidence: 51%

New-onset severe Diabetic Ketoacidosis in a 13-months old Nepali Toddler: a case report

Basnet,

Bhattarai,

Bhatt

et al. 2023

Nep. Med. Coll. J.

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“…Notably, diabetic ketoacidosis is the primary cause of death among individuals with diabetes . Therefore, failure to identify high-risk patients and provide timely treatment may lead to adverse outcomes and high mortality rate, particularly in low-income countries . Such failure may partly explain the lower rate of childhood diabetes-associated mortality in regions with higher SDI than in regions with lower SDI.…”

Section: Discussionmentioning

confidence: 99%

“…26 Therefore, failure to identify high-risk patients and provide timely treatment may lead to adverse outcomes and high mortality rate, particularly in low-income countries. 27 Such failure may partly explain the lower rate of childhood diabetes-associated mortality in regions with higher SDI than in regions with lower SDI. Additionally, cardiovascular disease contributes to mortality in children with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Global, Regional, and National Epidemiology of Diabetes in Children From 1990 to 2019

et al. 2023

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ImportanceDiabetes in children is a global epidemic that causes various medical conditions associated with an increased incidence of premature death.ObjectiveTo investigate the trends in diabetes incidence, mortality, and disability-adjusted life-years (DALYs) in children, with risk factors for diabetes-associated death, from 1990 to 2019.Design, Setting, and ParticipantsThis was a cross-sectional study that used data from the Global Burden of Diseases (GBD) 2019 in 204 countries and territories. Children with diabetes who were aged 0 to 14 years were included in the analysis. Data were analyzed from December 28, 2022, to January 10, 2023.ExposureChildhood diabetes from 1990 to 2019.Main Outcome MeasuresIncidence, all-cause and cause-specific deaths, DALYs, and corresponding estimated annual percentage changes (EAPCs). These trends were stratified according to region, country, age, sex, and Sociodemographic Index (SDI).ResultsA total of 1 449 897 children (738 923 male [50.96%]) were included in the analysis. In 2019, there were 227 580 incident cases of childhood diabetes worldwide. Cases of childhood diabetes increased by 39.37% (95% uncertainty interval [UI], 30.99%-45.45%) from 1990 to 2019. Over 3 decades, diabetes-associated deaths decreased from 6719 (95% UI, 4823-8074) to 5390 (95% UI, 4450-6507). The global incidence rate increased from 9.31 (95% UI, 6.56-12.57) to 11.61 (95% UI, 7.98-15.98) per 100 000 population; however, the diabetes-associated death rate decreased from 0.38 (95% UI, 0.27-0.46) to 0.28 (95% UI, 0.23-0.33) per 100 000 population. Among the 5 SDI regions, the low SDI region had the highest childhood diabetes-associated mortality rate in 2019. Regionally, North Africa and the Middle East had the largest increase in incidence (EAPC, 2.06; 95% CI, 1.94-2.17). Among 204 countries, Finland had the highest national incidence of childhood diabetes in 2019 (31.60 per 100 000 population; 95% UI, 22.65-40.36), Bangladesh had the highest diabetes-associated mortality rate (1.16 per 100 000 population; 95% UI, 0.51-1.70), and the United Republic of Tanzania had the highest DALYs rate (100.16 per 100 000 population; 95% UI, 63.01-155.88). Globally, environmental/occupational risk, nonoptimal temperature, high temperature, and low temperature were key risk factors for childhood diabetes-associated mortality in 2019.Conclusions and RelevanceChildhood diabetes is an increasing global health challenge with rising incidence. Results of this cross-sectional study suggest that despite the global decline in deaths and DALYs, the number of deaths and DALYs remains high among children with diabetes, especially in low SDI regions. Improved understanding of the epidemiology of diabetes in children may facilitate prevention and control.

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“…Our study shows a history of missing drug 9 (31%) was the most frequent precipitating factor followed by community-acquired pneumonia 6 (21%), and more than one factor 5 (17%) which statistically signi cant difference between no precipitating factors, p-value 0.000 (95%CI 2.18; 6.91). An institutional-based retrospective follow-up study in other parts of Ethiopia similarly reported that drug discontinuation had high odds of developing DKA (AIRR = 2.91, 95% CI = 2.02-4.22) (32). The study conducted in a tertiary care hospital, in Mysuru, has demonstrated infections in 57 (52%) and poor compliance to antidiabetic treatment in 23 (21%) being the most common cause of DKA (33).…”

Section: Dka Clinical Presentations and Investigationsmentioning

confidence: 98%

Characteristics and burden of diabetic ketoacidosis in diabetic patients in the period of COVID-19 outbreak in Ethiopia

Debela¹,

Assefa

Kedir

et al. 2023

Preprint

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Background: Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes mellitus. This study aimed to evaluate the clinical characteristics and the burden of DKA cases during the period of the COVID-19 outbreak in Ethiopia. Methods: An institutional-based retrospective chart review study was conducted. 178 randomly selected patients’ medical charts were included. Data were collected from medical records in the period between October 2020 to July 2022. To investigate the association between the dependent and independent variable, binary and multivariable logistic regression were done with statistically significant at P ≤0.05. Results: A total of 178 medical records were reviewed. The mean (±SD) age of the patients was 41.3 (±13.2) years and 45% of patients had type 2 diabetes. Acute diabetic complications were documented in 25.8% of patients where DKA was the commonest (16.3%). Nearly half of the DKA patients (n=13, 44.8%) were presented with poly-symptoms at the time of diagnosis. Furthermore, missing drug (31%) was the most frequent precipitating factor followed by community-acquired pneumonia (21%), and multiple factors (17%). Besides, patients in the DKA group had a higher mean length of hospital stay (3 days versus 2.6 days). Conclusion: The poly-symptoms were the common clinical features of DKA at the time of presentation. Pneumonia and a history of missing drugs were identified as leading precipitating factors of DKA. Even though the DKA complication is low in this research, diabetes health education at the community and institutional level, routine screening for diabetes at health centers, and treating the infections early are strongly recommended.

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Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia

Cited by 7 publications

References 29 publications

New-onset severe Diabetic Ketoacidosis in a 13-months old Nepali Toddler: a case report

New-onset severe Diabetic Ketoacidosis in a 13-months old Nepali Toddler: a case report

Global, Regional, and National Epidemiology of Diabetes in Children From 1990 to 2019

Characteristics and burden of diabetic ketoacidosis in diabetic patients in the period of COVID-19 outbreak in Ethiopia

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