Research Article - Clinical Investigation (2020) Volume 10, Issue 1

Characteristics of diabetic ketoacidosis in adult patients in Bahrain

Diabetic Ketoacidosis (DKA) is the most common and serious complication of diabetes worldwide [1]. In the Middle East region, mostly Arabs, it is estimated there are around 64,000 cases of type 1 diabetes, with an annual incidence of 10,700 cases [2]. Bahrain has a high prevalence rate of Diabetes, reached up to 48% in some populations [3]. H. Zayed conducted a descriptive quantitative study over 46 years in the Arab world to determine the rate of DKA in type 1 diabetes patients. The rate ranged from 17% to 100% with an overall rate of 46.7% [4]. Although the mortality rate of DKA has fallen significantly in the last two decades from 7.96% to 0.67%, but in developing countries, it is still high [5]. DKA is a metabolic derangement characterized by the triad of hyperglycemia, ketosis, and acidosis (bicarbonate <15 mmol/ l and arterial blood PH <7.3) mainly in type 1 diabetes patients, however, type 2 diabetes with metabolic decompensation could develop DKA [6,7]. The two most common precipitating factors are infections and inadequate insulin therapy, other factors, including myocardial infection, pancreatitis, trauma, cerebrovascular accident, alcohol, and drug abuse, provoke the release of counterregulatory hormones and might result in DKA [8,9]. Research shows that the optimal hospital site to manage DKA patients either general medical ward or Intensive Care Unit (ICU), should be based on the clinical prognostic indicators and the local availability of hospital resources. In some studies, up to 7.6% of DKA patients required ICU admission causing significant mortality, morbidity, and healthcare expenditure [10,11]. As most DKA cases occur in patients with a known history of diabetes, this acute metabolic complication can be prevented by patients’ education, training healthcare professionals, annual screening for complications, proper medications with approved indications, nutritionist visits, psychosocial support, and frequent blood glucose measurement. Many studies reported that improvement in the quality of care for diabetes was reflected by a decrease in diabetes-related hospitalizations [12-14]. A similar concept in Salmaniya Medical Complex was conducted as a weekly open clinic for diabetic patients that offer advice about sugar control and management.

Abstract

Introduction: DKA has long been considered and studied as a complication of type 1 diabetes in children, only a few studies showed the magnitude of the DKA among adults and type 2 DM. Objective: To evaluate the burden of adult admissions with DKA in Salmaniya Medical Complex-Bahrain, and try to identify the different trends. Methods: Retrospective study; data collected from medical records of adult patients, age 14 and above, who were admitted to Salmaniya medical complex with DKA in the period between January 2017 to December 2018 and fulfilled our inclusion criteria. The data included basic demographic information, and progress during admission. Results: We included 224 DKA admissions, the median age was 31.2 years, the rate of readmission was high as 33 patients were responsible for 102 admissions, mostly type 1 (93.5%) (p-value=0.011). In the analysis, we divided them into subgroups of new diagnoses 32 (14.3%), type 1 DM 147 (65.6%), type 2 DM 45 (20.1). Type 2 DM had higher comorbidities 25 (55.6%) (p-value<0.006), and higher antibiotic use 30 (66.7%) (p-value=<0.0001). Type 2 DM with DKA had 9.5 times higher risk for mortality compared to Type 1 DM with DKA, interestingly type 1 DM group had significantly lower hospital length of stay than the rest groups (2.7 vs 5.3 and 5.0) days. The total mortality was 5 (2.2%) Conclusion: DKA admissions are associated with significant morbidity, effort must be targeted at reducing the number of admissions, and mortality, possibly by enforcing health education, offering psychosocial support, creating policies to ensure continuous insulin supply and involving the primary care centers in the management of hyperglycemia and early DKA.

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