Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study

PLOS ONE RESEARCH ARTICLE Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospitalbased study Gizework Alemnew Mekonnen1*, Kassahun Alemu Gelaye2, Eyob Alemayehu Gebreyohannes1, Tadesse Melaku Abegaz ID1 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 School of pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia, 2 Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia * Abstract Background OPEN ACCESS Citation: Mekonnen GA, Gelaye KA, Gebreyohannes EA, Abegaz TM (2022) Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study. PLoS ONE 17(4): e0264626. https://doi.org/10.1371/ journal.pone.0264626 Editor: Paolo Magni, Università degli Studi di Milano, ITALY Received: July 4, 2021 Accepted: February 15, 2022 Published: April 5, 2022 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0264626 Copyright: © 2022 Mekonnen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This study did not receive funding. There was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia. Objective The aim of the study was to determine the treatment outcomes of DKA patients attending Debre Tabor General Hospital. Method A retrospective study was conducted at Debre Tabor General Hospital and data were collected from June 1 to June 30 of 2018. Participants included in the study were all diabetic patients with DKA admitted from August 2010 to May 31, 2018. The primary outcomes were the treatment outcomes of DKA including (in-hospital glycemic control, the length of hospital stay and in-hospital mortality). The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was presented in the form of means with standard deviation and binary regression was conducted to determine factors that affect length of hospital stay among DKA patients. Result 387 patients were included in the study. The mean age of patients was 33.30± 14.96 years. The most common precipitating factor of DKA was new onset diabetes mellitus 150(38.8%). The mean length of hospital stay was 4.64(±2.802) days. The mean plasma glucose at admission and discharge was 443.63(±103.33) and 172.94 (±80.60) mg/dL, respectively. The majority 370 (95.60%) of patients improved and discharged whereas 17 (4.40%) patients died in the hospital. Patients with mild and moderate DKA showed short hospital stay; AOR: 0.16 [0.03–0.78] and AOR:0.17[0.03–0.96] compared with severe DKA. Diabetic ketoacidosis precipitated by infection were nearly five times more likely to have long hospital PLOS ONE | https://doi.org/10.1371/journal.pone.0264626 April 5, 2022 1 / 15 PLOS ONE Competing interests: The authors have declared that no competing interests exist. Abbreviations: DTGH, Debre Tabor General Hospital; DKA, Diabetic Ketoacidosis; DM, Diabetes Mellitus; SD, Standard Deviation; SPSS, Statistical Package for Social Sciences; USA, United States of America. Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia stay than DKA precipitated by other causes; AOR: 4.59 [1.08–19.42]. In addition, serum glucose fluctuation during hospitalization increased the likelihood of long hospital stay, AOR: 2.15[1.76–2.63]. Conclusions New onset type 1 diabetes was the major precipitating factor for DKA. Admitted DKA patients remained in hospital for a duration of approximately five days. About five out of hundred DKA patients ended up with death in the hospital. Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. Early prevention of precipitating factors and adequate management of DAK are warranted to reduce length of hospital stay and mortality. Introduction Diabetes mellitus (DM) represents a group of metabolic disorders characterized by increased blood glucose concentration. The international diabetes federation estimated that 463 million adults were diagnosed for DM in 2019 [1–4]. Diabetic ketoacidosis (DKA) is an acute lifethreatening complication of DM. Multiple pathophysiologic factors have been postulated for the pathophysiology of DKA including oxidative stress and pro-inflammatory cytokines (i.e., tumor necrosis factor-alpha (TNF-α)) that might lead to inadequate insulin secretion or utilization in the body [5–10]. The clinical characteristics of DKA include polyuria, polydipsia, weight loss, vomiting, dehydration, fatigue, mental status change, Kussmaul respirations, tachycardia, and hypotension [11, 12]. A diagnosis of DKA is made when patients are presented with blood pH level of less than 7.30, and bicarbonate level below 18 meq/L along with certain level of mental status impairment [11, 13–15]. Diabetic ketoacidosis is associated with high mortality rates in the developing world [16, 17]. The poor management of DKA can lead to debilitating and potentially fatal complication including cerebral edema and severe hypoglycemia. Mortality of DKA has been reported to be less than 5% in treatment experienced centers of the Americas, Europe and Asia [18, 19]. In Africa, the mortality of DKA is unacceptably high with a reported death rate of 26 to 29% in studies from Kenya, Tanzania, and Ghana [8]. In Ethiopia, mortality from DKA was found be high [20]. A retrospective study conducted at Shashemene Referral Hospital reported that DKA contributed 12% in-hospital mortality [21]. Another study conducted in Hiwot Fana Specialized University Hospital indicated that about 11% of patients with diagnosis of DKA died in hospital [22]. In order to reduce mortality different countries have been undertaking different strategies and prevention measures including diabetes self-management education, increasing the pathophysiology of DKA and adoption of DKA treatment guidelines [19]. However, these strategies have not been appropriately implemented in Ethiopia. In addition, the cost and lack of medication supplies, presence of comorbid conditions, inappropriate insulin storage, medication non-adherence, electrolyte disturbance and smoking habits complicated the prevention and treatment of DKA in Ethiopia [21, 23, 24]. There was limited data on treatment outcomes including hospital stay, glycemic control (...truncated)