COMPARISON DIABETIC KETOACIDOSIS (DKA) ADMISSION AMONG TYPE 2 DIABETIC MELLITUS (T2DM) PATIENTS DURING PRE RAMADAN AND RAMADAN

ASSOCIATED FACTORS, OUTCOME AND SEVERITY

Abstract

INTRODUCTION
Risk for DKA was increased during Ramadan in patients with advanced micro- and macrovascular complications and renal insufficiency. Associated factors are noncompliance to insulin and infections. DKA admission in Ramadan leads to prolonged hospital stay and is associated with higher mortality.

METHODOLOGY
This is a retrospective study conducted in a tertiary hospital in Terengganu. All DKA admissions during Ramadan and 3 months pre-Ramadan from January 2015 to December 2019 were identified. Patients with T2DM who fasted during Ramadan were included in this study. Associated factors, outcomes (length of hospital stay and mortality) and severity of DKA in Ramadan and pre-Ramadan periods were compared. This study obtained ethical approval from 2 local ethical committees.

RESULT
There were 117 patients included in the study. The majority of admissions were males (54.2% pre-Ramadan, 61.8% Ramadan). The mean age was 47 years (pre-Ramadan) and 40 years (Ramadan). A majority had pre-existing T2DM pre-Ramadan (96.4%) and during Ramadan (97.1%), with most patients on insulin treatment: 66.3% and 94.1%, respectively. Mean HbA1c was 12.4% for pre-Ramadan and 12.0% for Ramadan. A majority had poor compliance with treatment at 83.1% and 100% in pre-Ramadan and Ramadan, respectively. Diabetes-related complications were present in 59% (pre-Ramadan) and 85.3% (Ramadan) of patients. Insulin treatment and diabetes-related complications were significantly associated with DKA during Ramadan (adjusted odd ratio [OR] 8.00, [2.16 – 52.48], p 0.007) (adjusted [OR] 3.97, [1.45 – 12.89], p 0.012), respectively. No significant difference was observed in length of stay (5 days vs. 4 days) and mortality rate (7.7% vs. 8.8%). The severity of DKA pre-Ramadan was similar (30.1% mild, 38.6% moderate, 31.3% severe). During Ramadan, the majority of patients were admitted as moderately severe (76.5%).

CONCLUSION
Insulin treatment and diabetes-related complications were associated with DKA admission in Ramadan. There was no observed difference in length of hospital stay and mortality between groups. Majority of patients presented with moderately severe DKA during Ramadan.