Evidence map›Paper›PMID 39060948›Full record

ArticleBMC endocrine disorders2024

Clinical presentation and outcomes of care in adults with diabetic ketoacidosis pre-COVID-19 and during-COVID-19 at a tertiary, referral hospital in Nairobi, Kenya.

Sairabanu Sokwalla, Jasmit Shah, Sangeeta Chauhan, Reena Shah, Salim Surani, Erick Njenga, Nancy Kunyiha

Abstract read
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Article in BMC endocrine disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

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3citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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3 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Sairabanu SokwallaAga Khan University, Nairobi, Kenya. Saira.sokwalla@aku.edu.
Jasmit ShahAga Khan University, Nairobi, Kenya.
Sangeeta ChauhanAga Khan University, Nairobi, Kenya.
Reena ShahAga Khan University, Nairobi, Kenya.
Salim SuraniTexas A&M University, Texas, USA.
Erick NjengaAga Khan University, Nairobi, Kenya.
Nancy KunyihaAga Khan University, Nairobi, Kenya.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrognosis of DKA has improved over time with the availability of evidence-based protocols and resources. However, in Kenya, there are limited resources for the appropriate diagnosis and management of DKA, mostly limited to tertiary-level referral facilities. This study aimed to review the clinical presentation, management, and outcomes of adult patients admitted with DKA and assess differences in these parameters before and during the COVID-19 pandemic.

methodsThis was a retrospective study of DKA admissions from January 2017 to December 2021. Patient data were retrieved from the medical records department using ICD-10 codes, and individual details were abstracted on clinical presentation, management, and outcomes of DKA. Comparisons were made between pre-COVID-19 and during COVID-19 durations.

results150 patients admitted with DKA were included (n = 48 pre- COVID-19, n = 102 during COVID-19 (n = 23 COVID-19 positive, n = 79 COVID-19 negative)). Median age was 47 years (IQR 33.0, 59.0), median HbA1C was 12.4% [IQR 10.8, 14.6]), and most patients had severe DKA (46%). Most common DKA precipitants were infections (40.7%), newly diagnosed diabetes (33.3%) and missed medication (25.3%). There was a significant difference in pulmonary infections as a DKA precipitant, between the pre- COVID and during COVID-19 pandemic (21.6% during COVID-19 versus 6.3% pre- COVID-19; p = 0.012). Median total insulin dose used was 110.0 units [IQR 76.0, 173.0], and a 100% of patients received basal insulin. Median length of hospital stay was 4.0 days [IQR 3.0, 6.0] and time to DKA resolution was 30.0 h [IQR 24.0, 48.0]. There were 2 deaths (1.3%), none directly attributable to DKA. Severity of DKA significantly differed between pre- COVID-19, COVID-19 positive and COVID-19 negative DKA (52.2% of COVID-19 positive had moderate DKA compared to 26.6% of COVID-19 negative and 22.9% of Pre-COVID-19 (p = 0.006)).

conclusionEven in developing regions, good outcomes can be achieved with the appropriate facilities for DKA management. Clinician and patient education is necessary to ensure early detection and prompt referral to avoid patients presenting with severe DKA. Exploratory studies are needed to assess reasons for prolonged time to DKA resolution found in this study.

Indexed as

COVID-19Diabetic KetoacidosisTertiary Care CentersAdultFemaleHospitalizationHumansKenyaMaleMiddle AgedPrognosisRetrospective StudiesSARS-CoV-2Aga Khan University Hospital.COVID-19Diabetes ketoacidosisDKAMortalityPrecipitants

Identifiers

PMID39060948
PMCPMC11282815

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.