Risk factors of diabetic ketoacidosis among patients with diabetes attending at public hospitals of East Gojjam Zone, Northwest Ethiopia: an unmatched case - control study.

Abstract

Background: Diabetic Ketoacidosis (DKA) is a critical and potentially fatal complication predominantly seen in individuals diagnosed with Type 1 Diabetes Mellitus (T1DM), though it may also arise in those with Type 2 Diabetes Mellitus (T2DM) under specific circumstances. Although DKA is preventable through effective diabetes management strategies, the consequences can be severe if the condition is not addressed promptly. The timely recognition of DKA, coupled with suitable medical treatment, is essential to enhance patient outcomes and mitigate the risk of enduring complications related to this condition. The objective of this research was to identify the risk factors of DKA in diabetic patients receiving care at public hospitals in the East Gojjam Zone of Northwestern Ethiopia.

Methods: An unmatched case-control study was carried out in selected public hospitals located in the East Gojjam Zone between April 10 and July 30, 2023. Five public hospitals were randomly selected, and a systematic random sampling technique was employed to recruit 408 study participants. Logistic regression analysis was performed to identify variables significantly associated with the outcomes, using a significance level of P < 0.05 and a 95% confidence interval.

Results: The study included 102 cases and 306 controls. Several key risk factors for DKA were identified, including the absence of regular follow-up [AOR = 2.21, 95% CI (1.31-3.71)], not being a member of health insurance [AOR = 3.30, 95% CI (1.75-6.24)], distance from a health facility greater than 5 km [AOR = 1.85, 95% CI (1.09-3.14)], infection [AOR = 2.15, 95% CI (1.12-3.89)], and reduction in insulin dosage [AOR = 2.13, 95% CI (1.19-3.83)].

Conclusions: The findings declared that lack of regular follow-up, living more than five kilometers from a healthcare facility, reducing insulin doses without adequate medical guidance, lack of community-based health insurance, and the presence of infections significantly increase the likelihood of DKA. Therefore, healthcare providers should intervene on the identified risk factors for DKA to prevent the occurrence of DKA.