Incidence and determinants of diabetic ketoacidosis among people with diabetes in Woldiya comprehensive specialized hospital, Ethiopia: a retrospective cohort study

Abstract

Introduction: Diabetic ketoacidosis is an acute complication of diabetes mellitus that is characterised by hyperglycemia, acidosis, and ketonuria. Diabetes is the most challenging public health problem in the twenty-first century for both developed and developing countries. Objective: To assess the incidence of Diabetic ketoacidosis and its determinants among adult people with diabetes at an Ethiopian Hospital. Method: An institution-based retrospective cohort study was conducted among 390 adult people with diabetes attending services at Wolida Comprehensive Specialized Hospital. The consecutive sampling method was used to select study participant charts. Data were collected using a checklist prepared from different literature. The data were entered into EPI data version 4.6.0.5 and exported to STATA version 14.0 for further analysis. The Wiebull model was the best fitted model that was selected using the log-likelihood ratio method and the Akakian information criterion. Hazard ratios with their 95% confidence interval and p-value were computed. Result: From the total 405 charts reviewed, 390 adult charts were included for analysis. A total of 121 DKA occurred from 5471 person–months of observation. The overall incidence rate of diabetic ketoacidosis was found to be 2.2 per 100 person-months (95% CI: 1.8- 2.6). Being urban dweller (AHR: 0.59, 95% CI: 0.36–0.99), having no family history of DM (AHR: 0.55, 95%CI: 0.31—0.97), presence of infection (AHR: 2.60, 95%CI = 1.06–6.39), having of any comorbidities (AHR: 4.31, 95% CI: 1.70–10.90), and having poor glycemic control (AHR: 7.45, 95% CI: 3.84–14.47) were significant determinants. Conclusion and recommendations: The overall incidence of diabetic ketoacidosis in study area was relatively high. Poor glycemic control, the presence of infection, and comorbidity were determinants of diabetic ketoacidosis. There is a need to have close follow-up of people with diabetes who have comorbidity, infection, and poor glycemic control.