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

Abstract

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.

Burden of diabetic ketoacidosis among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis

“…Open access and 0-263, respectively. 5 In developing countries, the mortality rate due to DKA ranges 6% to 24% and 2% to 5% in developed countries. 6 7 The most common precipitating factors provoking the release of counter-regulatory hormones for the development of extreme hyperglycaemia and subsequent DKA are infection, non-adherence to insulin treatment, acute major illnesses and antipsychotic agents.…”

“…2 Since patients with a known history of diabetes account for the majority of DKA occurrences, it can be avoided by health education, complication screening and frequent random blood glucose follow-ups. 5 In LMICs, including Ethiopia, the health system's capacity to manage DKA was very limited. Therefore, it is likely not properly diagnosed and treated, leading to delays or misdiagnosis that might increase the risk of complications and mortality.…”