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

Abstract

Background: Diabetic ketoacidosis is a morbid complication of diabetes mellitus, and its occurrence at diagnosis has rarely been studied in Ethiopia, despite the many cases seen in the pediatric population. Objective: To know the prevalence of diabetic ketoacidosis (DKA) among patients with newly diagnosed diabetes mellitus and identify avoidable risk factors. Method: This institution-based retrospective cross-sectional study was conducted from December 25, 2018 to December 25, 2022. Newly diagnosed type1 diabetes mellitus (DM) patients with age < 15 years were included in the study. DKA was diagnosed based on clinical presentation and blood glucose and urine ketone levels. A data collection form was prepared to collect sociodemographic and clinical data. Descriptive, bivariate, and multivariate logistic regression analyses were performed to identify the risk factors. Result: Among the admitted 61 newly diagnosed T1DM pediatric patients, DKA was the first presentation in 37 patients making 60.7% of newly diagnosed T1DM. Mean age at diagnosis was 8 years and females were affected more. Clinical presentation revealed vomiting accompanied by signs of dehydration (32.4%), with polysymptoms (29.7%) being the most common. Infectious morbidity occurred in 26 patients, 21 of whom were in the DKA group. Inadequate knowledge of signs and symptoms of DM adjusted odds ratio (AOR=0.07(0.019-0.0897), absence of a family history of DM (AOR=0.129 (0.019-0.897), and presence of infection prior to diagnosis of DKA (AOR=11.69(1.34-10.1) were potential predictors for the development of DKA among newly diagnosed T1DM patients. Conclusion: A very high number of children present with DKA at the initial diagnosis of diabetes mellitus (DM), which is attributed to inadequate knowledge of the signs and symptoms of DM and the masking effect of concomitant infections in these children. Healthcare professionals should endeavor to suspect and screen children. Continuous awareness creation of DM at the health professional and community levels is encouraged to diagnose diabetes mellitus earlier and to decrease the prevalence of DKA as an initial presentation. Key words: Child, diabetic ketoacidosis, Dilla, prevalence