Precipitating factors and clinical outcomes of diabetic ketoacidosis in Eastern Cape, South Africa

Abstract

Background: Diabetic ketoacidosis (DKA) is a common hyperglycaemic emergency in persons living with diabetes (PLWD), and outcomes of treatment depend on the precipitating factor.

Methods: A cross-sectional prospective study of patients admitted in the adult high care unit of Nelson Mandela Central Hospital was carried out from 19 February 2022 to 19 January 2023. Patients were assessed for demographic, clinical profiles and outcomes concerning precipitating factors. The outcomes were duration of admission and discharge from the hospital as alive or dead.

Results: There were 55 PLWD, all black African, predominantly females, known with diabetes with a mean age of 38 ± 15.8 years. The main precipitants for DKA in descending order were infections (47%), treatment omission (30%) and a new diagnosis of diabetes (19%). The mean duration of admission for all patients was 8.2 ± 5.3 days. The length of hospital stay was 9.5 ± 5.2 days, 5.6 ± 2.2 days, and 8.6 ± 7.6 days, respectively (p = 0.118). The mortality in all patients was 9 (16.4%), and all but one death was associated with sepsis. There were no significant differences in the HbA1c among patients with infection (13.9 ± 3.8), those who omitted treatment (12.6 ± 4.7) and those newly diagnosed (12.2 ± 2.2) (p = 0.620).

Conclusion: The high mortality rates in our DKA patients were mainly related to infections. The high HbA1c indicates poor glycaemic control preceding DKA. Improving glycaemic control, preventing infections, and early treatment of infections can reduce DKA-related mortality among patients.

Contribution: This study provides a comprehensive analysis of DKA in resource-limited settings, focusing on its precipitating factors, clinical profiles, and outcomes among adults in the Eastern Cape, South Africa. Infections were identified as the leading precipitant, with poor glycaemic control prevalent across all cases and a mortality rate of 16.4%, primarily due to sepsis. The findings highlight the urgent need for strategies to improve glycaemic control, prevent infections, and ensure timely interventions to reduce DKA-related mortality. This research aligns with the Journal of the Colleges of Medicine of South Africa’s mission to advance clinical practice by addressing critical healthcare challenges in underserved communities, offering insights applicable across the region.