Characteristics of diabetic ketoacidosis in adult patients in Bahrain

Abstract

Introduction: DKA has long been considered and studied as a complication of type 1 diabetes in children, only a few studies showed the magnitude of the DKA among adults and type 2 DM. Objective: To evaluate the burden of adult admissions with DKA in Salmaniya Medical Complex-Bahrain, and try to identify the different trends. Methods: Retrospective study; data collected from medical records of adult patients, age 14 and above, who were admitted to Salmaniya medical complex with DKA in the period between January 2017 to December 2018 and fulfilled our inclusion criteria. The data included basic demographic information, and progress during admission. Results: We included 224 DKA admissions, the median age was 31.2 years, the rate of readmission was high as 33 patients were responsible for 102 admissions, mostly type 1 (93.5%) (p-value=0.011). In the analysis, we divided them into subgroups of new diagnoses 32 (14.3%), type 1 DM 147 (65.6%), type 2 DM 45 (20.1). Type 2 DM had higher comorbidities 25 (55.6%) (p-value<0.006), and higher antibiotic use 30 (66.7%) (p-value=<0.0001). Type 2 DM with DKA had 9.5 times higher risk for mortality compared to Type 1 DM with DKA, interestingly type 1 DM group had significantly lower hospital length of stay than the rest groups (2.7 vs 5.3 and 5.0) days. The total mortality was 5 (2.2%) Conclusion: DKA admissions are associated with significant morbidity, effort must be targeted at reducing the number of admissions, and mortality, possibly by enforcing health education, offering psychosocial support, creating policies to ensure continuous insulin supply and involving the primary care centers in the management of hyperglycemia and early DKA.