Recurrent Diabetic Ketoacidosis: Predictors and Clinical Outcomes in a 24-Year Retrospective Cohort
https://doi.org/10.15605/jafes.041.S1
- Author:
Liang Wei Wong
1
;
Lisa Mohamed Nor
2
;
Raja Nurazni binti Raja Azwan
1
;
Adilah Zulaikha binti Abd Latib
1
;
Hidayatil Alimi bin Keya Nordin
1
;
Qin Zhi Lee
1
;
Kean Heng Lim
1
;
Jia Ling Low
1
;
Mohd Fyzal bin Bahrudin
1
;
Syaza binti Izhar Hisham
1
;
Jia Whey Jacelyn Ong
2
;
Chin Voon Tong
1
Author Information
1. Endocrine Unit, Medical Department, Hospital Putrajaya
2. Clinical Research Centre, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Diabetic Ketoacidosis;
Retrospective Studies
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):33-34
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Diabetic ketoacidosis (DKA) is a life-threatening complication associated with significant morbidity and healthcare
burden. Despite advances in diabetes care, recurrent
DKA remains common, often reflecting gaps in treatment
adherence and patient education. Identifying predictors
of recurrence is crucial for risk stratification and targeted
intervention.
Methodology:We conducted a retrospective observational study of all
adult DKA admissions to a tertiary centre between 2001
and 2025. Electronic medical records were reviewed for
demographic data, biochemical parameters, precipitating
factors, and clinical outcomes. DKA was defined using standard biochemical criteria. Recurrent DKA was defined as ≥2 admissions during the study period. Factors associated
with recurrent DKA admissions were analyzed. Patients
under the age of 18 years and those with missing vital
information were excluded.
Results:A total of 667 DKA admissions, comprising 566 patients,
were identified, of which 101 admissions (15.1%) were
recurrent, involving 65 patients. Among recurrent DKA
episodes, the most common precipitating factors were
infection (64.4%) and insulin omission (62.4%). After
multivariate analyses, patients with type 1 diabetes
mellitus (T1DM) were more likely to develop recurrent
DKA compared to those with type 2 diabetes mellitus
(aOR 4.16; 95% confidence interval [CI] 2.58–6.70; p <0.001).
Insulin omission was strongly associated with recurrent
DKA (aOR 2.29; 95% CI 1.46–3.60; p <0.001). In contrast,
baseline glycated hemoglobin and chronic kidney disease
were not significantly associated with recurrence. Diabetic
counseling during the first DKA admission did not reduce
recurrent DKA. There were no significant differences in
mortality (3.9% vs 6.2%, p = 0.524) or critical care admission
rates (40.6% vs 38.7%, p = 0.718) between recurrent and first
DKA episodes.
Conclusion:Recurrent DKA accounts for a substantial proportion of
DKA admissions and is strongly associated with insulin
omission and T1DM. Our findings suggest that recurrent
DKA is driven predominantly by behavioral and adherencerelated factors, indicating the need for multidisciplinary
interventions beyond standard inpatient counseling.
- Full text:2026072815371970941EP_A028.pdf
