Prevalence and Associated Factors of Diabetic ketoacidosis among Patients Living with Type 1 Diabetes in Makkah Al-Mukarramah City

Abstract

ObjectiveTo assess magnitude of diabetic ketoacidosis (DKA) among type-1 diabetics and to identify associated risk factors.MethodsA cross-sectional study was conducted among 236 type-1 diabetics in Makkah Al-Mukarramah City, Saudi Arabia.ResultsAmong participants, 59.3% were males, 44.1% were diabetic for more than 5 years, while 70.8% reported past history of DKA. The main causes of DKA were “first presentation of the disease” (40.9%), and “discontinued treatment” (37%). The HbA1c among 53.6% was above 9%. Almost all cases who experienced DKA were hospitalised (98.8%). Out of them, 9 (5.4%) suffered complications. Female patients were more likely to suffer from episodes of DKA than males (76% and 68.3%, respectively). Most patients whose parents’ highest education was primary level had DKA more frequently than those whose parents’ had postgraduate education. Patients with unemployed fathers had significantly higher frequency of DKA (p=0.004). Ketoacidosis was significantly more frequent among patients with parents’ consanguinity (p<0.001). Patients who had their current HbA1c level exceeding 9% had positive history of DKA compared to those with HbA1c level ≤7% (87.9% and 28.6%, respectively, p<0.001).ConclusionMost type-1 diabetics experience DKA, mainly with their first presentation of disease or due to discontinuation of treatment. DKA tends to occur more frequently among female patients, those with less educated parents or when their parents are relatives.ADVANCES IN KNOWLEDGEThis study rang a warning bell towards parents’ consanguinity among type-1 diabetics as a risk factor for diabetic ketoacidosis.The current search revealed the lack of public’s awareness about type-1 diabetes and its complications as well as their low compliance towards its treatment, since diabetic ketoacidosis occurred mainly at the first presentation of the disease among diabetics, or due to treatment discontinuation.APPLICATION TO PATIENT CAREThis study indicated the importance of raising the public’s awareness regarding early symptoms of diabetes among their children so as to be ready to seek medical advice as early as possible before the occurrence of complications.Health education messages should be repeatedly broadcast via mass media explaining the hazards associated with consanguineous marriages.Health care providers should stress to diabetic patients and/or their caregivers the importance of compliance to treatment.

Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study

“…as reflected by high HbA1c levels and increased prevalence of DKA among children and adolescents with T1DM. [9][10][11] Children and adolescents with T1DM need to follow a structured self-management plan that incorporates appropriate insulin use, blood glucose monitoring, adequate physical activity and a healthy balanced diet to ensure good glycaemic control and prevent diabetesrelated complications. 2 However, self-management activities remain suboptimal among this group of patients in many countries, including Saudi Arabia and Malaysia.…”

“… 8 In addition, several studies from Saudi Arabia reported highlighted poor glycaemic control as reflected by high HbA1c levels and increased prevalence of DKA among children and adolescents with T1DM. 9–11 …”