EC Paediatrics

Background: Diabetic Ketoacidosis (DKA) is a life-threatening complication of Type 1 Diabetes Mellitus (T1DM). It remains a major cause of morbidity and mortality in children, often serving as the first presentation of the disease or a complication in established cases. This study aims to assess the prevalence of DKA among newly diagnosed pediatric patients and identify precipitating factors in known T1DM patients.

Methods: An institution-based retrospective cross-sectional study was conducted at St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa. Data were collected from the medical records of pediatric patients (aged <18 years) presented with T1DM between January 2017 and December 2022. Consecutive sampling was used to include 184 patients (84 newly diagnosed and 100 known T1DM with DKA). Data were analyzed using SPSS version 26.0.

Results: Among 84 newly diagnosed T1DM patients, 75 (89.3%) presented with DKA as their initial manifestation. Of these, 35.7% had severe DKA. A significant association was found between the lack of health insurance and DKA presentation at diagnosis (AOR 0.025, 95% CI 0.002-0.332, p = 0.005). Among the 100 known T1DM patients presenting with DKA, infection was the leading precipitating factor, accounting for 50% of cases, followed by insulin omission (13%).

Conclusion: The prevalence of DKA at the onset of T1DM is alarmingly high in this setting, with the vast majority of new patients presenting in crisis. Lack of health insurance is a significant barrier associated with delayed diagnosis. For known patients, infection remains the primary trigger for DKA. Strategies to improve early diagnosis and focused education on sick-day management are urgently needed.

 Keywords: Diabetic Ketoacidosis; Type 1 Diabetes Mellitus; Pediatrics; Ethiopia; Precipitating Factors

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