Comparative Analysis of Diabetic Ketoacidosis in Adults With Type 1 and Type 2 Diabetes Mellitus: Insights From a Saudi Arabian Cohort.

Abstract

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication commonly seen in Type 1 diabetes mellitus (T1DM) but also affects Type 2 diabetes mellitus (T2DM). Objectives: To compare the clinical presentation, biochemical parameters, and precipitating factors of DKA in adult patients with T1DM and T2DM. Methodology: This retrospective cohort study was conducted at King Salman Hospital, Riyadh, involving medical records of diabetic patients aged 14 years or older who attended the Diabetic Center from September 1, 2021, to August 1, 2022. Data collection included sociodemographic, clinical, biochemical, and management details using a standardized checklist. Results: The study included 285 patients with DKA, aged 14-70 years (mean: 23.1 ± 11.5 years), with 52.5% being male. The most common symptoms were nausea (91.1%), abdominal pain (86.1%), vomiting (83.6%), polyuria/polydipsia (74.1%), and shortness of breath (72.4%). Vomiting and abdominal pain were more frequent in T1DM (85.9% and 88.3%) compared to T2DM (65.6% and 68.8%), p=0.004 and 0.003, respectively, while dizziness was more common in T2DM (56.3% vs. 33.2%), p=0.011. Uric acid and creatinine levels were significantly higher in T2DM, whereas hemoglobin and hematocrit were elevated in T1DM. Poor compliance was the most common precipitating factor (70.2%), followed by upper respiratory tract infection (21.1%) and inadequate treatment (15.6%). Conclusion: This study highlights key differences in DKA presentation between T1DM and T2DM. While symptoms such as nausea and abdominal pain were common in both types, vomiting was more frequent in T1DM and dizziness in T2DM. Biochemical markers such as uric acid and creatinine were elevated in T2DM, while hemoglobin and hematocrit were higher in T1DM. Poor compliance was a more common precipitating factor in T1DM, whereas inadequate treatment prevailed in T2DM. Tailored management approaches for each diabetes type may improve DKA outcomes.