Determinants of Diabetes Ketoacidosis Among Diabetes Mellitus patients at North Wollo and Waghimra Zone Public Hospitals, Amhara Region, Northern Ethiopia

Background: Diabetes Mellitus (DM) is a metabolic disorder associated with acute nonmetabolic and metabolic complications. Diabetic ketoacidosis is the most serious diabetic emergency in patients with diabetes mellitus. It is the leading cause of mortality in children and young adults. Even though the burden of diabetes ketoacidosis has increased over the past years in Sub-Saharan Africa, no research has been conducted on the determinants of Diabetes ketoacidosis in Ethiopia, particularly in the Amhara region. Thus, this study aimed to identify the determinants of diabetes Ketoacidosis among Diabetes Mellitus patients at North Wollo and Waghimra Zone public Hospitals. Methods: An institution-based unmatched case-control study design was employed on 408 patients (102 cases and 306 controls) at North Wollo and Waghimra Zone Public Hospitals from March 1 st to April 30 th , 2020. A consecutive sampling method was used to select study participants. The data were collected using structured interviewer-administered questioners and reviewing of patient charts. The analysis was done using a binary logistic regression model. Then, P-value < 0.05 was considered statistically significant. Result: The mean (±SD) age of the study participants was 46.96 (± 15.175 SD) years. Irregular follow-up in diabetes clinic (AOR:4.19, 95% CI :2.28-7.71), not received diabetic education (AOR: 2.87, 95% CI:1.44-5.72), alcohol drinking (AOR:2.99, 95% CI :1.46-6.12), discontinuation of medications (AOR: 4.31, 95% CI:1.92-9.68), presence of comorbidity (AOR:2.57, 95% CI :1.37-4.84), and being type one of diabetes mellitus (AOR: 2.01, 95% CI:1.11-3.63) were determinant factors of diabetic ketoacidosis . Conclusions: This study showed that the behavioral and clinical characteristics of diabetic patients were risk factors of diabetic ketoacidosis. Follow-up in the diabetic clinic, diabetic education, discontinuation of medications, alcohol drinking, presence of comorbidities, and type of diabetes mellitus were independent determinants of diabetic ketoacidosis.