Pattern and outcome of Diabetic Ketoacidosis among children with Type 1 Diabetes mellitus at Ile-Ife, Nigeria

Abstract

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of Diabetes mellitus. There are few reports on the pattern and outcome of DKA in childhood diabetes in Nigeria but none on the diabetic population from Osun State, Nigeria. Objective: To determine the pattern and factors influencing the outcome of children managed for DKA at the Paediatric Endocrinology Unit of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, over a ten-year period. Methods: A retrospective review of the clinical records of all the children managed for Type-1 Diabetes mellitus (TIDM) over ten years (2007-2016) was done. Relevant information was obtained from the clinical records and the data were analyzed. Results: A total of 15 children with DKA comprising 8 (53.3%) males and 7 (46.7%) females were studied. The male to female ratio was 1.1:1. Twenty-eight episodes of DKA were recorded during the period, thus putting the average frequency per patient at 1.9. DKA was the first manifestation of DM in the majority (86.7%) of the subjects. The mean age at diagnosis of DM was 11.9+3.6 years with about half (53.3%) occurring during pre-adolescence. The socio-economic status of the affected families had an inverse relationship with the frequency of DKA. Conclusion: DKA is the most common initial presentation of Type-1 DM among Nigerian children, with a high rate of recurrence and an inverse relationship with socioeconomic status.

Diabetic Ketoacidosis in Children with Type-1 Diabetes in a Tertiary Hospital in Sokoto, North-Western Nigeria: Clinical Profile and Outcome

“…Majority of our study population were from lower socioeconomic class, in consonant with the reports from Enugu [14], and Ife [18], South-East and South-west, Nigeria respectively. The latter study reported an inverse relationship between socioeconomic class and the frequency of DKA.…”

“…The clinical features observed are similar to those reported in studies from Nigeria [10,11,14,17], other parts of Africa [1,19], and Asia [5,26,27], with only slight differences, particularly in the order of frequency. Whilst abdominal pain was the commonest symptom in our study, similar to a study in Himalayan, North India [26], polyuria [5,10,14,18], respiratory distress [19,27] and vomiting [27], were the commonest symptoms reported from studies within{10, 14, 18} and outside Nigeria [5,19,27]. Most of the Nigerian studies [10,14,18] set out to study DKA in the newly diagnosed T1D patients.…”

“…Whilst abdominal pain was the commonest symptom in our study, similar to a study in Himalayan, North India [26], polyuria [5,10,14,18], respiratory distress [19,27] and vomiting [27], were the commonest symptoms reported from studies within{10, 14, 18} and outside Nigeria [5,19,27]. Most of the Nigerian studies [10,14,18] set out to study DKA in the newly diagnosed T1D patients. This may explain why polyuria was the commonest presenting symptom of DKA seen in these studies, more so that previous authors had reported polyuria, as being commoner in the newly diagnosed T1D children with DKA compared to those with established diabetes with DKA [27].…”

“…There are few reports on DKA in the childhood diabetic population in Nigeria [10,14,[17][18] and other African countries [1,19,20]. Most of these reports focused on DKA at onset of T1D only.…”

<p>A Ten-Year Review of the Pattern and Outcome of Childhood Diabetes in Two State Teaching Hospitals in South-West Nigeria</p>

“…Diabetic ketoacidosis was an initial presentation in 65.0% of the patients managed for diabetes. Even though this value is not as high as the values reported by many authors in Nigeria and Africa, 8,9,16,17 it is still higher than what is found in developed countries such as the USA (25.5%) 18 and Sweden (15.2%) 19 and suggests that most patients with diabetes in this environment will present with DKA at the point of diagnosis. It is worthy of note that 83.3% of the patients at LTH centre presented with DKA which is similar to other single centre experiences in Nigeria and Africa.…”