This study was aimed to assess the prevalence and associated factors of diabetic ketoacidosis among adult patients admitted in emergency department of Hawassa university comprehensive specialized hospital. An institution based retrospective cross-sectional study design was conducted among 195 adult patients aged 16 years and above with known or previously unknown diabetes cases presented in the emergency unit.
Result
In our study from the total 195 patients medical record reviewed 78 [40%] developed DKA. Out of the total reviewed medical record 55 [28.2%] and 23 [11.8%] were with type-1 and type 2 diabetes mellitus respectively. From acute complication of diabetes, diabetic ketoacidosis was a leading cause 78 [77%] followed by hypoglycemia 14 [14%] and hyperosmolar hyperglycemic state [9%]. During multiple logistic regression analysis age and hypertension were found to have significant association with diabetic ketoacidosis.
Introduction
Diabetes is a group of metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both [1]. Diabetes mellitus DM] is a group of common metabolic disorders that share the phenotype of hyperglycemia, which are caused by a complex interaction of genetics and environmental factors. It is the leading cause of end-stage renal disease, traumatic lower extremity amputations, and adult blindness. In Ethiopia study shows the prevalence of DKA among acute complication of DM was 68.3% and 71% in Dessie and Jimma respectively [2].
The major classifications of diabetes are type-1 diabetes which is caused by β-cell destruction and type-2 diabetes that results from insulin resistance. Type-1 DM covers 5–10% of all diabetes and type-2 DM covers 90–95% of all diabetes [3]. Diabetes and its complications are major causes of early death in most countries, with cardiovascular disease being the leading cause of death among people with diabetes [4].
Diabetes mellitus leads to acute and chronic complications include diabetic ketoacidosis [DKA], hyperosmolar hyperglycemic state, and hypoglycemia during treatment. Diabetic ketoacidosis [DKA] is one of the most serious acute complications of DM. Ketoacidosis occurs when stored triglyceride broken down into fatty acid which serves as alternate sources of fuel, which causes elevation of blood ketone leads to ketoacidosis [5].
The common causes of DKA are missed dose of insulin, illness or infection, and undiagnosed or untreated diabetes. The main clinical features of DKA are hyperglycemia, dehydration, electrolyte loss, and acidosis [6]. Diabetic ketoacidosis [DKA] occurs commonly in people who have type 1 diabetes. However, people who have type 2 diabetes may also develop diabetic ketoacidosis [7].
In Africa, 19.8 million people or 4.9% are estimated to have diabetes in 2013 [8]. In Ethiopia, WHO estimates the number of cases of diabetics to be about 800,000 in 2000 and projected that it would increase to about 1.8 million by the year 2030 [9]. The same studies conducted in Ethiopia from 1970 to 2011 suggested that DM prevalence in the country was about 2%, rising to > 5% in persons aged ≥ 40 years in certain settings [10]. A more recent nationwide World Health Organization [WHO] Steps survey among 2153 persons in Ethiopia found the DM prevalence to be 6.5% [11].
DKA is one of the most fatal acute complications among DM patient. Its mortality rate ranges from 2 to 5 percent in developed countries and 6 to 24 percent in developing countries. If it misdiagnosed or mistreated, it is 100% fatal [12]. In some studies it has been reported that DKA can be present in 25% to 30% of type 1 diabetes cases at onset and from 4 to 29% in youth with type-2 diabetes [13].
Several studies were conducted on diabetes mellitus and its complication, but few studies were done on the prevalence and factors associated with DKA among Ethiopian patients. As a result of this information’s are scant to promote better health service to prevent mortality due to DKA in Ethiopia.
Main text
Methods and materials
Study design, area and period
Institution based retrospective cross-sectional study design was conducted at Hawassa university comprehensive specialized hospital from February 01–30/2018. Hawassa is the capital city of SNNPR of Ethiopia, which is 273 km far from South of Addis Ababa. The hospital gives service for about 18 million people of SNNPR and neighboring areas of Oromia regional state. It has 350 beds for admitted patients. The hospital provides different service through inpatient and outpatient level. The hospital’s emergency unit gives services for approximately 10,000 patients per year. The emergency unit has more than 33 beds and 10 rooms for emergency admission.
Population
All adult DM patients who visited Hawassa university comprehensive specialized hospital emergency unit from January, 2016 to January, 2018 were the source population. Diabetes patients, who visited adult emergency unit of Hawassa university comprehensive specialized hospital from January, 2016 to January, 2018 and those who fulfill the inclusion criteria were the study population.
Sample size and sampling technique
Single population proportion formula was used to calculate sample size with the assumption of, 5% margin of error, 95% confidence interval and 71% proportion of DKA from a study conducted in Jimma University teaching hospital [2]. Since the source population was