Frequency of Diabetes ketoacidosis (DKA) occurrence among adult Diabetes Mellitus patients in Ethiopia: A Negative Binomial Regression analysis

Abstract Introduction Diabetes ketoacidosis (DKA) is a life-threating acute complication of Diabetes Mellitus (DM) characterized by the triad of hyperglycemic crisis, ketosis, and acidosis. The frequency of DKA occurrences is an important indicator of both the adherence to management protocols and the quality of life of DM patients. However, information regarding the frequency and predictors of DKA among adult DM patients is limited in Ethiopia. Therefore, this study is aimed at investigating the frequency and associated factors of DKA among DM patients in northwest Ethiopia. Methods An institutional-based retrospective cohort study was conducted at Debre Tabor Comprehensive Specialized Hospital among 370 randomly selected patients. Data were extracted from patients' medical records, entered with Epidata 4.6 software, and exported to Stata 16.0 software for analysis. A zero-inflated negative binomial regression model was fitted to identify determinants of recurrent episodes of DKA. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals were used to declare statistical significance. Results In the final analysis, all 370 (100%) study participants were included, with over half (208, or 56.2%) being type II DM patients. Throughout the three-year follow-up period, approximately 76.2% (95% CI: 71.9–80.0) of participants developed DKA, and among them, more than three-quarters (75.2%) experienced recurrent DKA attacks. Residing in a rural area (AIRR = 1.48, 95% CI: 1.26–1.74), being unable to read and write (AIRR = 1.52, 95% CI: 1.13–2.04), having primary-level educational status (AIRR = 1.55, 95% CI: 1.18–2.05), having type I DM (AIRR = 1.62, 95% CI: 1.28–2.05), not being enrolled in health insurance (AIRR = 1.26, 95% CI: 1.10–1.48), and having other comorbidities (AIRR = 1.54, 95% CI: 1.29–1.81) increase the frequency of DKA attacks. Conclusion and Recommendation: In this study, a high frequency of DKA was observed, with over three-quarters of DKA patients experiencing recurrent attacks. Rural residence, low educational attainment, type I DM, lack of health insurance enrollment, and comorbidities were identified as contributing factors. Stakeholders are urged to boost community engagement in health insurance, enhance socio-economic status, and prioritize type II DM patients and those with comorbidities.