A 5 Years Audit Report on Diabetic Ketoacidosis Patients from a Tertiary Care Hospital in Saudi Arabia

Objective: To evaluate the causes of high admission rate of diabetic ketoacidosis (DKA) in adults with diabetes mellitus presenting to a tertiary care hospital in Saudi Arabia with specific emphasis on the clinical and biochemical phenotype and identify components of intervention and improve clinical outcomes in these patients. Study Design: Observational study. Place and Duration of the Study: Department of Diabetes & Endocrinology, Armed Forces Hospital Al-Hada, Taif, Kingdom of Saudi Arabia from 1st August 2015 to 31st January 2020. Methodology: One hundred and fifteen patients with diabetes mellitus presenting with diabetic ketoacidosis during the last 5 years were enrolled. Approximately 50 different variables pertaining to the patients at the time of presentation were thoroughly scrutinized. Results: There were 31 (28%) males and 81 (72 %) were females with type 1 DM 92%, type 2 DM 7% and 1% unclassified DM with a mean age of 20.90 +/- 7.4 years. 18% were diagnosed to have DM for the first time and others had a mean duration of DM of 8.0 +/- 3.6 years with an average daily insulin requirement being 64.0 +/- 20.2 units. Moreover 84% of patients were on basal bolus regimen and only 5% were on mixed insulin. 73% of the DKA episodes occurred in 15-25 years of age group. The commonest precipitating factors were non-compliance with insulin (44%) and respiratory tract infections (17%). Most common presenting symptoms were vomiting and abdominal pain present in 81% and 53% of patients. The mean blood sugar on presentation was 463 +/- 157.3 mg/dl whereas the mean HbA1c was 14 +/- 2.9. The mean pH and bicarbonate levels on presentation were 7.16 +/- 0.128 and 7 +/- 4.83 meq/L respectively. 80% of the patients were admitted to the general wards however 19% required ICU care. 69% of patients had a history of readmission with DKA and 29% were transferred from another periphery hospital. The mean duration of stay in the hospital was 2 +/- 3.8 days and the mortality was 0.9%. Conclusion: A very low mortality rate is witness to excellent acute management of these very sick patients. However a very high non-compliance rate of 44%, combined with a readmission rate of 69% and a mean HbA1c of 14% are very alarming as far as long term prognosis is concerned.