Original Research Article
Year: 2020 | Month: September | Volume: 10 | Issue: 9 | Pages: 15-25
The Incidence of Diabetic Ketoacidosis and Its Relationship with Residential Areas of Adults with Type 1 Diabetes in Nigeria
Collins Amadi1, Olufisayo G. Ayoade1, Sarah I. Essien2, Aniete A. Etuk3, Chidozie J. Okafor3, Enobong N. Udoh4, Ofonmbuk O. Umoh4
1Consultant Chemical Pathologist, Department of Chemical Pathology, University of Uyo Teaching Hospital, Nigeria
2Lecturer 11, Department of Chemical Pathology, University of Uyo, Nigeria
3Senior Registrar, Department of Chemical Pathology, University of Uyo Teaching Hospital, Nigeria
4Registrar, Department of Chemical Pathology, University of Uyo Teaching Hospital, Nigeria)
Corresponding Author: Collins Amadi
ABSTRACT
Objectives: Area of residence impacts diabetic ketoacidosis (DKA) incidence in Sub-Sahara Africa, however, this is yet to be validated. Hence, this study explored the impact of area of residence on DKA incidence among adult Nigerians with type 1 diabetes (TIDM).
Methods: This survey was conducted retrospectively using medical records of adults (≥18 years) presenting with new-onset T1DM complicated with DKA at the Emergency Unit of the University of Uyo Teaching Hospital (UUTH) in Nigeria over 5 years. All relevant socio-demographic, clinical, and biochemical data at the point of TIDM diagnosis complicated with DKA were retrieved and analyzed based on urban-rural differences using standard protocols.
Results: 155 TIDM presented at the Emergency Unit of which 145(93.6%) were complicated with DKA. The mean age at DKA diagnosis was 32.68±5.91 years (range 23-46) with male preponderance (n=74;51%;p=0.049). Of those with DKA, the urban-dwellers predominated (n=82;56.6%) with female preponderance, were relatively younger, and had a higher rate of the most likely DKA trigger - infection. The urban-dwellers also had a higher frequency of polyuria (p<0.001), lower systolic blood pressure, higher plasma glucose, potassium, and creatinine, worse grades/risk of DKA-defined hyperglycemia (HR:1.202;p=0.004), metabolic acidosis (HR:1.242;p=0.0017), ketonuria (HR:1.102;p<0.001) and a greater likelihood of DKA episode (OR:2.288;p=0.007) following adjustment for confounders.
Conclusion: DKA at TIDM diagnosis was highly prevalent in the studied region and was associated with a greater likelihood to occur among adults in urban areas. Hence, health-targeted policies are highly recommended.
Key words: Diabetes; Adult-onset Type 1 diabetes mellitus; diabetic ketoacidosis