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 Table of Contents 
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 6  |  Page : 2676-2679  

Level of awareness of diabetic ketoacidosis among diabetes mellitus patients in Riyadh


1 College of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
2 Al-Maarefa University, Riyadh, Saudi Arabia

Date of Submission14-Mar-2020
Date of Decision25-Apr-2020
Date of Acceptance08-May-2020
Date of Web Publication30-Jun-2020

Correspondence Address:
Dr. Bara'a Ahmad Farran
Al.Worood District, Najd National School, P.O. Box: 85822 Riyadh 11612, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_385_20

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  Abstract 


Background: Diabetic ketoacidosis (DKA) is considered to be a serious acute life-menacing complication of diabetes type (1) and type (2). The study aims to assess the level of awareness regarding DKA among diabetic patients in the Riyadh population. Methodology: The study is an institution-based cross-sectional study with a sample size of 150 participants. The participants are chosen through systemic random sampling, who have type (1) or type (2) diabetes mellitus patients and are 18–35 years of age. The medical personnel were excluded from the study. A self-administered, precoded, and pretested questionnaire was developed especially for this study after consulting literature and epidemiologists containing data about the risk factor, management, and complication. Data were analyzed using (SPSS). A P value of less than 0.05 was considered significant. Results: 38.67% (58) participants have poor awareness regarding complications, 67.34% (101) have poor knowledge regarding management, and 6% (9) participants have a good knowledge, 38% (57) participants have poor knowledge regarding risk factors and 30% (45) of the participants have good awareness. The relation between having a first degree relative with diabetes and awareness regarding management is significant with a P value of 0.022; 73% (110) of the participants had no relatives with diabetes mellitus and 71% (79) had a poor level of awareness regarding the management of DKA. However, 55% (22) of respondents who had relatives with diabetes mellitus also had a poor level of awareness regarding treatment. Conclusion: The majority of the participants had a poor level of awareness. There is a relationship between having a first-degree relative with diabetic mellitus and the level of awareness regarding DKA.

Keywords: Awareness, complication, diabetic ketoacidosis, management, risk factors, Riyadh


How to cite this article:
Farran BA, Bin Elaiwah RI, Aldarsouny AT, Alshamrani AM, Almaslamani AM, Alsubie BF, Zainab MM, Alkulaib MO, Khalifah A. Level of awareness of diabetic ketoacidosis among diabetes mellitus patients in Riyadh. J Family Med Prim Care 2020;9:2676-9

How to cite this URL:
Farran BA, Bin Elaiwah RI, Aldarsouny AT, Alshamrani AM, Almaslamani AM, Alsubie BF, Zainab MM, Alkulaib MO, Khalifah A. Level of awareness of diabetic ketoacidosis among diabetes mellitus patients in Riyadh. J Family Med Prim Care [serial online] 2020 [cited 2020 Aug 15];9:2676-9. Available from: http://www.jfmpc.com/text.asp?2020/9/6/2676/287885




  Introduction Top


Diabetes mellitus (DM) is a group of metabolic disorders caused by elevated blood glucose level due to the diminishing effects of circulating insulin, insulin resistance, or increased production of counterregulatory hormones.[1]

Diabetic ketoacidosis (DKA) is considered to be a serious, acute life-menacing complication of diabetes types 1 and 2. The main factors that expedite the development of DKA are the complete lack of insulin or missed insulin doses. Besides, recurrent DKA is counting to be 20% as a result of contributing factors such as socioeconomic disadvantage, age (13–25 years), gender (female more than male) and psychiatric comorbidities like eating disorders and depression.[1],[2],[3],[4]

However, it rarely occurs without precipitating events. The DKA patients presented with different clinical manifestations such as polyuria with polydipsia (98%), weight loss (81%), muscles fatigue (62%), dyspnea (57%), vomiting (46%) and preceding illness (40%). These symptoms may lead to severe complications in the respiratory system and gastrointestinal system and cause respiratory failure and severe abdominal pain, respectively, which may lead to coma and death. The incidence of DKA ranges from 16% to 80% in children newly diagnosed with diabetes depending on the geographic location.[2],[3],[5]

In Europe, there is a high incidence of DKA among diabetic patients in the following countries: Romania (67%), Hungary (23%), and Finland (22%). Furthermore, other countries in the Arabian Gulf such as the United Arab Emirates, Kuwait, and Saudi Arabia had DKA incidence of 80%, 20.9% and 44.9%, respectively, during 1990 to 1999. Although there has been an elevation in the incidence rates of DKA between 2011 and 2013, there is a lack of researches and studies about DKA in Riyadh.[6]

To ensure the safety and well-being of our children, it is almost mandatory to have access to respectful and professional primary care centers as well as having a good primary care physician because it was proven to have much better health outcomes. Multiple evidence around the world proved that spreading and raising awareness about diabetes and DKA was effective in the less likely occurrence rate of DKA when T1DM is first diagnosed. The occurrence of DKA may be due to the parents' lack of awareness regarding the symptoms of hyperglycemia. Having a first-degree relative with diabetes is associated with regressed risk of DKA at diabetes. A study conducted in Poland showed that the children were more prone to DKA and the frequency increased two-fold in children under the age of 3 compared to the general population.[7],[8]


  Methodology Top


This is a hospital-based cross-sectional study, conducted in Riyadh, the capital city of Saudi Arabia, with population around 6,506,700. The study included type 1 and type 2 diabetes mellitus patients of age 18–35 years and excluded medical personnel; the sample size was 150 participants who were chosen through systematic random sampling. Data collected through a precoded and pretested questionnaire was developed specifically for this study after consulting literature and epidemiologist. Descriptive analysis and categorization of data containing frequencies and percentages was performed using SPSS version. 24. A P value of 0.05 or less was considered significant. The investigator explained the purpose of study and obtained a verbal consent from the parents or guardians of the children guardians before data collection.


  Results Top


As shown in [Table 1], 75.3% were males and the remaining were female. 78% were of the age 30–35, 13.3% were of the age 26–30, and the remaining were of the age 18 to 25. Regarding marital status, 70.7% were married, 15.3% were single, and 10% were divorced and the remaining were widowed. Regarding occupation, 52.7% were employed, 30.7% were unemployed, and the remaining were self-employed. Regarding education, 46% had secondary education, 32.7% went to university, 13.3% have only taken primary education, and the remaining were illiterate. 48% owned a villa, 26.7% were living in a rented apartment, 15.3% were living in the owned apartment, and the remaining were living in rented villas.
Table 1: Demographic data

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As shown in [Table 2], 38% %, 32%, and 30% of the participants have poor, moderate, and good DKA risk factor awareness, respectively.
Table 2: The level of awareness regarding DKA risk factor

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As shown in [Table 3], 67.34%, 26.66%, and 6% of the participants have poor, moderate, and good knowledge regarding DKA management, respectively.
Table 3: The level of awareness regarding DKA management

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As illustrated in [Table 4], 38.67% of our participants have a poor awareness regarding DKA complications.
Table 4: The level of awareness regarding DKA complication

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[Table 5] shows that among 73% (110) of the participants who had no relative with diabetes mellitus, 71% (79) had a poor level of awareness regarding the management of DKA and 55% (22) of respondents who had relatives with diabetes mellitus had a poor level of awareness regarding treatment. A P value of 0.022 was considered significant and shows that the hypothesis of the relationship between having a first-degree relative with diabetes and awareness regarding management of (DKA) is true.
Table 5: The relation between having a first degree relative with diabetes and awareness regarding management of (DKA)

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  Discussion Top


The majority of participants have poor knowledge about the DKA risk factors and only a few had good knowledge, which is in line with a study by Mirsadraee in Iran.[9] We recommend the health department authorities to emphasize the main risk factors that have a direct relation with DKA.

The majority of the participants have poor knowledge regarding the management of DKA while only a few have good knowledge. This is in line with the results of a study done by Singh H, in India,[10] that shows half of the participants did not have knowledge about the clinical features and management of DKA. We recommend MOH to invest more in health education regarding DKA management.

The majority of the participants have poor knowledge about DKA complication and a few have moderate knowledge, similar to the findings of a study conducted by Ullah F in Peshawar, Pakistan. It found that 46.75% of diabetic patients had poor knowledge regarding DKA as a complication of diabetes.[11] We recommend the MOH to establish effective health education regarding DKA complications.

In this research, the results show that there is a relationship between having a first degree relative with diabetes and awareness regarding management of DKA, which is in line with a study done by L. de Vries in Tel Aviv [12] In this research, we encourage the health authorities to provide a more effective way to teach society about DKA management.


  Conclusion Top


In conclusion, the majority of the participants have a poor level of awareness and there is a relationship between having a first-degree relative with diabetic mellitus and the level of awareness regarding DKA. The MoH should invest more in health education among diabetic patients. Besides, we encourage other researchers to publish more studies about the DKA.

Financial support and sponsorship

Our financial support was taken from “Al-Maarefa University”.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wolfsdorf J, Craig ME, Daneman D, Dunger D, Edge J, Lee WR, et al. Diabetic ketoacidosis. Pediatr Diabetes 2007;8:28-42.  Back to cited text no. 1
    
2.
Al-Rubeaan KA, Aftab SA, Alotaibi MS, Alghamdi AA, Rafiullah MR. Clinico-laboratory characteristics of diabetic ketoacidosis in adults. Eur Rev Med Pharmacol Sci 2011;15:1202-6.  Back to cited text no. 2
    
3.
Seth P, Kaur H, Kaur M. Clinical profile of diabetic ketoacidosis: A prospective study in a tertiary care hospital. J Clin Diagn Res 2015;9:OC01-4.  Back to cited text no. 3
    
4.
Ehrmann D, Kulzer B, Roos T, Haak T, Al-Khatib M, Hermanns N. Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes. Lancet Diabetes Endocrinol 2020;8:436-46.  Back to cited text no. 4
    
5.
Dorin RI, Murata GH, Tzamaloukas AH. Respiratory failure in diabetic ketoacidosis. World J Diabetes 2015;6:1009-23.  Back to cited text no. 5
    
6.
Robert AA, Al-Dawish A, Mujammami M, Dawish MAA. Type 1 diabetes mellitus in Saudi Arabia: A soaring epidemic. Int J Pediatr 2018;2018:9408370. doi: 10.1155/2018/9408370.  Back to cited text no. 6
    
7.
Madkhly TM, Mohammed FA, Majrashi HH, Kamili FH, Tawhari RAM, Hudisy AA. Final-year medical students' awareness and knowledge about DKA: A cross-sectional study from a Saudi University. J Family Med Primary Care 2020;9:1076-9.  Back to cited text no. 7
    
8.
Szypowska A, Ramotowska A, Grzechnik-Gryziak M, Szypowski W, Pasierb A, Piechowiak K. High frequency of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes. J Diabetes Res 2016;2016:9582793. doi: 10.1155/2016/9582793.  Back to cited text no. 8
    
9.
Mirsadraee R, Khajedaluee M, Vakili R, Hasanabade A, Saeedrezaee Z. Factors associated with newly diagnosed children with diabetic ketoacidosis. J Pediatr Rev 2017;5;65-71.  Back to cited text no. 9
    
10.
Singh H, Thangaraju P, Kumar S, Aravindan U, Balasubramanian H, Selvan T. Knowledge and awareness of diabetes and diabetic ketoacidosis (DKA) among medical students in a tertiary teaching hospital: An observational study. J Clin Diagn Res 2014;8:4-6.  Back to cited text no. 10
    
11.
Ullah F, Afridi AK, Rahim F, Ashfaq M, Khan S, Shabbier G, et al. Knowledge of diabetic complication in patients with diabetes mellitus, Peshawar, Pakistan. J Ayub Med Coll Abbottabad 2015;27:360-3.  Back to cited text no. 11
    
12.
de Vries L, Oren L, Lazar L, Lebenthal Y, Shalitin S, Phillip M. Factors associated with diabetic ketoacidosis at onset of type 1 diabetes in children and adolescents. Diabet Med 2013;30:1360-6.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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