Mortality and its predictors in Adult Diabetic ketoacidosis patients in East Africa: A 2025 Systematic review and meta-analysis

Abstract

Background Diabetes ketoacidosis occurs at an estimated rate between 4.6 and 8 episodes per 100 patient-years in individuals with diabetes. Up to 47% of diabetes-related ketoacidosis deaths have been reported in East Africa, which is an unacceptably high rate. Socioeconomic factors, including cost and the unpredictability of insulin supplies, as well as social, cultural, and economic factors, contribute to the difficulty in controlling ketoacidosis in patients in Africa. Objectives To conduct systematic review and meta-analysis on mortality and its predictors among diabetic ketoacidosis patients in East Africa: A 2025 Systematic review and meta-analysis. Methods A Comprehensive search of MEDLINE (via PubMed), the Cochrane Database of Systematic Reviews, UpToDate, EMBASE, and NICE (National Institute for Health and Care Excellence) was performed to identify studies reporting mortality and its predictors in adult patients with diabetes ketoacidosis in East Africa. A Random effect- model was applied for pooled diabetes ketoacidosis mortality incidence. The quality of the studies was assessed using the Newcastle-Ottawa scale. The evaluation of publication bias revealed no evidence of bias. Results The final analysis included 2,260 patients from 11 studies. The pooled incidence of mortality among patients with diabetic ketoacidosis in East Africa was 12.02% (95% CI: 5.99–18.04; I 2 = 89.9%; p < 0.001). Comorbidity (OR = 2.15; 95% CI: 1.56–2.74) and sepsis (OR = 1.77; 95% CI: 1.60–1.95) were found to be significant predictors of diabetic ketoacidosis related mortality. Conclusion The overall incidence of mortality among adult patients with diabetic ketoacidosis in East Africa remains high. The presence of comorbidity and sepsis increases mortality among adult patients with diabetic ketoacidosis.