Biochemical profiles and precipitating factors of diabetic ketoacidosis among type 1 and type 2 diabetes patients: a retrospective analysis from Syria.

Abstract

Background: Diabetic ketoacidosis (DKA) is a life-threatening metabolic emergency characterized by hyperglycemia, ketosis, and acidosis due to insulin deficiency and counterregulatory hormone imbalances. Its prevalence is notably higher in the Arab world than in Western regions. Understanding biochemical differences between type 1 and type 2 diabetes patients with DKA is essential for individualized treatment strategies. This study examines the biochemical profiles and precipitating factors of DKA in Syrian patients, assessing differences between initial and recurrent episodes amid local healthcare challenges.

Methods: This retrospective study has ethical approval from Damascus University and Damascus Hospital, allowing access to patient charts. The study included individuals diagnosed with diabetic ketoacidosis (DKA) and admitted to Damascus Hospital. Of 997 patients, 464 charts were excluded due to missing data or uncertain diagnoses. Patients were classified into first-time and recurrent DKA, with only initial episodes considered for analysis. Diagnosis criteria varied by age group, ensuring standardized classification. Laboratory tests were performed exclusively in the hospital's central lab. Extracted variables included demographic details, hospitalization duration, diabetes type, precipitating factors, and biochemical markers.

Results: The study analyzed 533 hospital admissions for diabetic ketoacidosis (DKA), with 263 (49.3%) being first episodes. Among these, 126 patients (47.9%) had type 1 diabetes, and 71 (26.9%) were diagnosed with diabetes after their first DKA episode. Type 2 diabetes patients exhibited higher in-hospital mortality (16.0% vs. 4.3%, p < 0.001) and longer hospital stays. Significant biochemical differences were observed between types, particularly in pH, bicarbonate, and creatinine levels. Insulin omission and unknown precipitating factors were common, especially in recurrent DKA cases.

Conclusions: In conclusion, DKA as the first presentation of diabetes is prevalent among Syrian patients. Type 1 patients were more acidotic, but their admission was shorter, probably due to comorbidities among type 2 patients. Unknown factors and insulin omission are the most prevalent triggers of DKA, especially among patients with recurrent episodes.

Clinical trial number: Not applicable.