Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana.
Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana.
Trop Med Int Health. 2023 Sep;28(9):790-796. doi: 10.1111/tmi.13919. Epub 2023 Aug 3.
Diabetic ketoacidosis (DKA) is a common, severe and often fatal complication of diabetes. This study aimed to investigate the clinical characteristics and precipitants of DKA, as well as factors associated with DKA severity in Ghanaian patients.
Cross-sectional study of the medical records of all 70 adult patients >18 years managed for DKA in the adult emergency room of Korle-Bu Teaching Hospital in Ghana from March 2019 to July 2019. DKA diagnosis was based on hyperglycaemia >11.0 mmol/L, ketonuria (more than 2+) plus acidaemia of (pH < 7.3) or bicarbonate (HCO ) <15.0 mmol/L. However, when serum bicarbonate and pH were not available, clinical signs of acidosis, for example, Kussmaul breathing aided in the diagnosis. DKA severity was assessed based on the Joint British Diabetes Societies (JBDS) guidelines of factors suggestive of severe DKA. Multivariable logistic regression was used to determine the factors associated with DKA severity. Odds ratio and 95% confidence interval for factors associated with DKA severity were determined.
The mean (±standard deviation) age, diabetes duration and blood sugar at admission were 44.06 (±16.23) years, 7.19 (±6.04) years and 26.37 (±6.70) mmol/L, respectively. Females comprised 51.4% of the study population. The most common presenting symptoms were generalised weakness (30.0%) and fever (14.3%). The major precipitants were infection (70.0%) and non-compliance (22.9%). Overall, 71.4% of participants had features suggestive of severe DKA. In a multivariable regression model, Type 2 diabetes was associated with over fourfold decreased odds of severe DKA (OR 0.23, 95% CI [0.07-0.76], p = 0.016). Patient education on prevention of DKA was documented for only 18.6% of patients before being discharged.
In this study, more than 70% of the study participants had features suggestive of severe DKA, with infection being the most common precipitant of DKA. 51.4% of patients had Type 2 diabetes which was associated with a statistically lower risk of severe DKA. Female sex tended to be positively associated with DKA severity. In a setting where the venous/arterial pH and bicarbonate levels may be inaccessible and/or unaffordable, using clinical features as found in the JBDS guidelines may help categorise patients and escalate care when needed. Indeed it may be useful to validate the use of the JBDS criteria for use in such settings.
糖尿病酮症酸中毒（DKA）是糖尿病的一种常见、严重且常可致命的并发症。本研究旨在调查加纳患者 DKA 的临床特征和诱因，以及与 DKA 严重程度相关的因素。
这是一项 2019 年 3 月至 7 月在加纳科勒布教学医院成人急症室接受 DKA 治疗的所有 70 名年龄大于 18 岁的成年患者的病历的横断面研究。DKA 的诊断基于高血糖症（>11.0mmol/L）、尿酮体（多于 2+）加上酸中毒（pH<7.3）或碳酸氢盐（HCO3-）<15.0mmol/L。然而，当血清碳酸氢盐和 pH 值不可用时，酸中毒的临床体征（例如，Kussmaul 呼吸）有助于诊断。DKA 的严重程度基于英国糖尿病协会（JBDS）严重 DKA 提示因素指南进行评估。多变量逻辑回归用于确定与 DKA 严重程度相关的因素。确定与 DKA 严重程度相关的因素的比值比（OR）和 95%置信区间（CI）。
平均（±标准差）年龄、糖尿病病程和入院时血糖分别为 44.06（±16.23）岁、7.19（±6.04）岁和 26.37（±6.70）mmol/L。女性占研究人群的 51.4%。最常见的首发症状是全身乏力（30.0%）和发热（14.3%）。主要诱因是感染（70.0%）和不遵医嘱（22.9%）。总体而言，71.4%的参与者有严重 DKA 的特征。在多变量回归模型中，2 型糖尿病与严重 DKA 的几率降低四倍以上相关（OR 0.23，95%CI [0.07-0.76]，p=0.016）。在出院前，只有 18.6%的患者接受了预防 DKA 的教育。
在这项研究中，超过 70%的研究参与者有严重 DKA 的特征，感染是 DKA 最常见的诱因。51.4%的患者患有 2 型糖尿病，与严重 DKA 的风险降低统计学相关。女性的 DKA 严重程度往往呈正相关。在静脉/动脉 pH 值和碳酸氢盐水平可能无法获得和/或负担不起的情况下，使用 JBDS 指南中发现的临床特征可能有助于对患者进行分类，并在需要时升级治疗。事实上，验证 JBDS 标准在这种情况下的使用可能是有用的。
