Frequency and associated risk factors of recurrent diabetic ketoacidosis among Saudi adolescents with type 1 diabetes mellitus

ABSTRACT

To explore the frequency and associated risk factors of recurrent diabetic ketoacidosis [RDKA] among Saudi adolescents with type 1 diabetes mellitus [T1DM]. A cross-sectional study was conducted among 103 T1DM adolescents [aged 13-18 years, 57 males] who were hospitalized for diabetic ketoacidosis][DKA] between January 2013 and May 2014 at Prince Sultan Military Medical City [PSMMC], Riyadh, Kingdom of Saudi Arabia. The respondents were purposively, conveniently selected, and interviewed using a structured Arabic questionnaire including clinical information and demographics. Fifty-six participants had experienced one episode of DKA, 41 had 2 episodes, and 6 had >/=3 episodes. Compared with adolescents who had hemoglobin A1c [HbA1c] adolescents with >9 HbA1c. Similarly, adolescents who stopped insulin and those with lipodystrophy at the injection site had a higher frequency of RDKA. Discontinuing insulin [67%] was the major reason for RDKA followed by infection [31%]. Among adolescents who discontinued insulin treatment, 31 [46.3%] gave no reason for stopping, 25 [37.3%] reported feeling sick, 7 [10.4%] gave a combination of reasons, and 4 [6%] reported a lack of supplies or other reasons. Regression analysis revealed that a higher HbA1c level and the presence of lipodystrophy were independent risk factors for RDKA. The frequency of RDKA was significantly greater in the T1DM adolescents with a higher HbA1c level, lipodystrophy, and those who had discontinued insulin treatment. Comprehensive multidisciplinary diabetes education should be offered to control modifiable risk factors in these patients