Clinical Profile, Precipitating Factors, and Glycemic Trends in Patients with Diabetic Ketoacidosis: A Tertiary Care Experience.

BACKGROUND

Diabetic ketoacidosis (DKA) remains the most frequent acute hyperglycemic emergency in individuals with diabetes mellitus and continues to impose a significant clinical and healthcare burden. Contemporary data reflecting regional precipitating factors and inpatient glycemic evolution are essential for optimizing prevention and management strategies.

AIMS: To evaluate the clinical profile, precipitating factors, infectious spectrum, and short-term glycemic trends among patients admitted with DKA in a tertiary care center.

MATERIALS AND

METHODS

This 5-year observational mixed retrospective and prospective study included 543 adult patients diagnosed with DKA based on standard biochemical criteria. Baseline demographic characteristics, precipitating factors, infection subtypes, and serial inpatient blood glucose values were systematically recorded and analyzed. Descriptive statistics were used to summarize clinical patterns and temporal glycemic changes during hospitalization.

RESULTS

Newly diagnosed diabetes emerged as the most frequent precipitating factor for DKA (37.6%), followed closely by insulin omission or noncompliance (36.6%) and infection (35.7%). Among infection-related cases, pneumonia and urinary tract infections predominated, with notable contributions from pulmonary tuberculosis and soft tissue infections. Acute systemic stressors, including myocardial infarction, stroke, surgery, and trauma, accounted for 12.5% of DKA episodes. Serial glycemic monitoring showed a significant progressive decline in blood glucose levels from day 1 to day 5 during hospitalization (Friedman's test, χ 2 (4) =744.324, P < 0.001).

CONCLUSIONS

DKA in this cohort was predominantly associated with new-onset diabetes, insulin nonadherence, and infection, particularly respiratory infections. Early detection of diabetes, structured adherence programs, and aggressive infection surveillance may substantially reduce preventable DKA episodes. Standardized inpatient management resulted in consistent and progressive metabolic recovery.