Incidence and predictors of diabetic ketoacidosis among adults with type 1 diabetes in Northwest, Ethiopia, 2023: a retrospective cohort study

Abstract

Diabetic ketoacidosis (DKA) is a serious, potentially fatal diabetes complication, particularly in low-resource settings, marked by hyperglycemia, ketoacidosis, and ketonuria. Mortality from DKA remains high in developing countries, including Ethiopia. Despite its impact, data on DKA’s incidence and predictors are limited in Ethiopia. To determine the incidence and predictors of DKA among adults with type 1 diabetes in Amhara regional state hospitals, 2023. A five-year retrospective cohort study was conducted, analyzing records from September 11, 2017, to September 10, 2022. Data extraction occurred from April 12 to May 28, 2023, using simple random sampling to select 634 participant records. Data were entered and analyzed with EPI data version 4.6.0.6 and STATA version 17. Among participants, 240 (39.8%) developed DKA, with an incidence rate of 15.96 per 100 person-years (95% CI: 14.04, 18.12). Significant predictors of DKA included middle age (AHR: 0.35, 95% CI: 0.21, 0.58), sex (AHR: 0.72, 95% CI: 0.55, 0.95), family history of diabetes (AHR: 1.45, 95% CI: 1.01, 2.11), long disease duration (AHR: 13.30, 95% CI: 9.09, 19.46), poor glycemic control (AHR: 2.29, 95% CI: 1.70, 3.08), recent acute illness (AHR: 1.41, 95% CI: 1.06, 1.87), comorbidities (AHR: 1.78, 95% CI: 1.34, 2.38), and medication noncompliance (AHR: 2.35, 95% CI: 1.76, 3.15). DKA incidence remains high in this cohort. Interventions should focus on improving glycemic control, medication compliance, and managing comorbidities to reduce DKA risk. Additionally, education targeting those with long disease duration and a family history of diabetes is recommended to prevent DKA.