Home Browse Mortality and its predictors in Adult Diabetic ketoacidosis patients...
ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
▬
✚
Systematic Review

Mortality and its predictors in Adult Diabetic ketoacidosis patients in East Africa: A 2025 Systematic review and meta-analysis

[version 1; peer review: awaiting peer review]
Gebremeskel Kibret Abebe
https://orcid.org/0000-0001-8985-6291
1, Zewdu Bishaw Aynalem2, Fentahun Meseret3, Melsew Dagne Abate4, Ahmed Nuru Muhamed5
Gebremeskel Kibret Abebe
https://orcid.org/0000-0001-8985-6291
1, Zewdu Bishaw Aynalem2, [...] Fentahun Meseret3, Melsew Dagne Abate4, Ahmed Nuru Muhamed5
PUBLISHED 03 Sep 2025
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS AWAITING PEER REVIEW

Abstract

Background

Diabetes ketoacidosis occurs at an estimated rate between 4.6 and 8 episodes per 100 patient-years in individuals with diabetes. Up to 47% of diabetes-related ketoacidosis deaths have been reported in East Africa, which is an unacceptably high rate. Socioeconomic factors, including cost and the unpredictability of insulin supplies, as well as social, cultural, and economic factors, contribute to the difficulty in controlling ketoacidosis in patients in Africa.

Objectives

To conduct systematic review and meta-analysis on mortality and its predictors among diabetic ketoacidosis patients in East Africa: A 2025 Systematic review and meta-analysis.

Methods

A Comprehensive search of MEDLINE (via PubMed), the Cochrane Database of Systematic Reviews, UpToDate, EMBASE, and NICE (National Institute for Health and Care Excellence) was performed to identify studies reporting mortality and its predictors in adult patients with diabetes ketoacidosis in East Africa. A Random effect- model was applied for pooled diabetes ketoacidosis mortality incidence. The quality of the studies was assessed using the Newcastle-Ottawa scale. The evaluation of publication bias revealed no evidence of bias.

Results

The final analysis included 2,260 patients from 11 studies. The pooled incidence of mortality among patients with diabetic ketoacidosis in East Africa was 12.02% (95% CI: 5.99–18.04; I2 = 89.9%; p < 0.001). Comorbidity (OR = 2.15; 95% CI: 1.56–2.74) and sepsis (OR = 1.77; 95% CI: 1.60–1.95) were found to be significant predictors of diabetic ketoacidosis related mortality.

Conclusion

The overall incidence of mortality among adult patients with diabetic ketoacidosis in East Africa remains high. The presence of comorbidity and sepsis increases mortality among adult patients with diabetic ketoacidosis.

Keywords

DKA, Diabetes ketoacidosis, Mortality, East Africa, predictors

Corresponding author: Gebremeskel Kibret Abebe
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2025 Kibret Abebe G et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Kibret Abebe G, Bishaw Aynalem Z, Meseret F et al. Mortality and its predictors in Adult Diabetic ketoacidosis patients in East Africa: A 2025 Systematic review and meta-analysis [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:864 (https://doi.org/10.12688/f1000research.169430.1) First published: 03 Sep 2025, 14:864 (https://doi.org/10.12688/f1000research.169430.1) Latest published: 03 Sep 2025, 14:864 (https://doi.org/10.12688/f1000research.169430.1)

Background

According to the International Diabetes Federation (IDF), the prevalence of diabetes was estimated to be 9.3% (463 million) in 2019 and is projected to reach 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045.1 Globally, half a billion people have diabetes, and this figure represents a 25% increase in the number of diabetes by 2030, and 51% increase by 2045.1 Diabetes-related deaths have increased significantly, accounting for approximately five million deaths over the past ten years.

The life-threatening acute consequences of diabetes mellitus include diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and hypoglycemia associated with treatment.1,2 DKA is the most common and potentially life-threatening acute complication of DM that progresses rapidly to life treating illness; thus, it requires immediate medical intervention.3

In the US, 30 million diabetic patients suffer from diabetic ketoacidosis.4 There are an estimated 4.6–8 episodes of DKA for every 100 years of diabetes. The majority of DKA cases occurred in the 18–44 age range (56%). The next most common age range is 45–65 years (24%).5

Over the past two–three decades, the prevalence of DKA has dramatically increased in Africa, leading to serious economic issues with increased drug use and bed occupancy.6,7 Patients in Africa face significant challenges in managing diabetes and preventing ketoacidosis due to socioeconomic factors, such as the cost and unpredictable nature of insulin supplies, as well as social, cultural, and economic factors.8–11 Poorly controlled diabetes mellitus associated with DKA, which can lead to neurologic complications and death.3,12

In Africa, deaths due to diabetic ketoacidosis are disproportionately high and vary markedly, ranging from 7.5% in Zambia13 to 47.8% in Rwanda,14 with intermediate rates of 15.1% in Ethiopia15 and 29.8% in Kenya.16 Notably, such variations were also observed within individual countries. These findings highlight the need for a systematic review and meta-analysis to generate a strong conclusion that can guide both clinical practice and policy-making.

Several factors have been identified as significant predictors of DKA-related mortality, including smoking, infection, presence of comorbidities, severe hypokalemia, inadequate potassium replacement, insulin administration errors, sepsis, inappropriate fluid administration, age, severity of DKA, renal failure, aspiration, and altered mental status.13,17–21

Although several studies have been conducted in various East African countries, the findings are inconsistent ranges from 1.3%-47.8%. Such variability may pose challenges for clinical decision making and draw sound conclusions. Therefore, this study aimed to determine the incidence of DKA-related mortality and its predictors, with the result that the finding is intended to support clinicians and stakeholders in patient outcomes.

Methods

Data sources and searching strategies

This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines used to report observational studies.22 The authors conducted a comprehensive search of the literature published between March 2008 and June 2025 across several databases, including MEDLINE (via PubMed), NICE (National Institute for Health and Care Excellence), UpToDate, EMBASE, and the Cochrane Database of Systematic Reviews. Ongoing systematic reviews were assessed using PROSPERO. PubMed Medical Subject Headings (MeSH) and text terms such as “diabetes keto acidosis”, “mortality”, and “hyperglycemic emergency”, and/or related factors were searched, either separately or in combination. Hand searches of reference lists were conducted, alongside adapted searches for other databases and forward citation searches using Web of Science and Google Scholar. The search strategy also included gray and unpublished literature (Supplementary Table 1).23

Study selection and screening

This systematic review and meta-analysis included cross-sectional, prospective cohort, and retrospective follow-up studies reporting mortality and its predictors among adult patients with diabetic ketoacidosis in East Africa. Studies that did not address diabetes ketoacidosis mortality or its predictors or studies that lacked sufficient data for analysis were excluded. Only complete manuscripts published in English were included.

Based on predefined study selection criteria, two authors (N.A. and A. G.) independently reviewed the studies for eligibility. The retrieved studies were exported to EndNote version 8 reference managers to remove possible duplicate studies. After screening the titles, abstracts, and keywords, the full texts of all potentially relevant studies were retrieved. Studies reporting mortality and its predictors among adult patients with diabetic ketoacidosis in East Africa were included.23 Additionally, any differences among the authors regarding the selection and inclusion of papers will be discussed and addressed ( Figure 1).

b5dbb1ee-f118-4b5b-8812-9631c9dc50aa_figure1.gif

Figure 1. PRISMA 2021 flow diagram showing the results of the search, the selection process of included studies and reasons for exclusion.

Inclusion and exclusion criteria

This systematic review and meta-analysis included studies reporting mortality and its predictors among adult patients with diabetic ketoacidosis. However, studies that did not report mortality due to diabetic ketoacidosis or its associated factors or insufficient data for analysis were excluded. The search focused on the study population, regardless of intervention, comparison, or outcome. Studies published in English were also included, whereas studies without abstracts and full texts, as well as qualitative studies, were excluded.

Data quality assessment

The Newcastle-Ottawa Scale was used to assess the quality of the included studies.24 Two authors (N.A and A.G) evaluated the quality of the studies before selecting them for analysis. Observational studies were assessed in three categories: selection (four questions), comparability (two questions), and outcome of interest (three questions), each of which received one point if the study met the criteria, except for the comparability of research groups, where two points were awarded if the study was adjusted for age, sex, or both, and for other confounding factors (Supplementary Table 2). The included studies had average quality in this systematic review and meta-analysis. Disagreements were resolved by consensus among the authors and collective re-evaluation of the relevant articles.

Data extraction

The primary objective of this systematic review and meta-analysis was to estimate the pooled mortality related to diabetic ketoacidosis among adult patients with diabetes in East Africa. The secondary outcome was the identification of factors that predict the occurrence of mortality among adult patients with diabetic ketoacidosis. Two independent authors (A. Z. and M. F.) extracted data using a predetermined data collection Microsoft Excel spreadsheet controlled by two others (A. G. and N. A.). The extracted data included the name of the first author, year of publication, study design, sample size, number of study populations, odds ratio, incidence of mortality related to diabetes ketoacidosis, diabetes ketoacidosis severity, patient age, sex, hospital length of stay, insulin administration, potassium supplementation, infection, and presence of comorbidities. In certain cases, the study’s first and final authors were emailed to obtain information on any ambiguities or missing reports. One month later, a second email was sent if there was no response.23

Stastical analysis

We computed the weighted mortality of diabetic ketoacidosis with corresponding 95% CI using the random-effect model described by Desrimonian and Liard.25 The Meta and Forest Plot programs in STATA version 17 were used for statistical pooling and quantitative data analysis of the meta-analyses and forest plots. Heterogeneity within the group was assessed using the I2 test, which determines the proportion of total variation among trials. Subgroup analysis was employed to address heterogeneity by defining the study design, sample size, study, and country of the study. A sensitivity test was conducted to assess the contribution of single studies to the pooled incidence of mortality due to diabetic ketoacidosis. Publication bias was assessed by visual inspection of the funnel plot using the Meta bias Egger test and Meta-trim fill analysis.23

Result

Following title and abstract review, 3207 of the 3278 records retrieved from various databases were excluded. Finally, 51 studies were screened for full-text review, and 11 articles met the inclusion criteria and were included in the final analysis ( Figure 1).

Study characteristics of included studies

In this systematic review and meta-analysis, 11 studies (n = 2260) were included: eight retrospective and three cross-sectional studies that aimed to estimate the pooled incidences of mortality among patients with DKA. Six studies from Ethiopia, two from Kenya, and one each from Tanzania, Rwanda, and Zambia contributed data for analysis. Overall, 192 deaths occurred among 2260 hospitalized patients with diabetic ketoacidosis ( Table 1).

Table 1. Study characteristics of included studies.

S.no Author nameYearStudy countryStudy designStudy populationNumber of deathsIncidences of mortality
1.Sairabanu S et al262023KenyiaRetrospective15021.3%
2.Shabani I et al272017TanzaniaRetrospective29724.1%
3.François R et al142021RwandaCross-sectional 231147.8%
4.Kassaye D et al152018EthiopiaRetrospective3575415.1%
5.Getu T et al202021EthiopiaRetrospective2252712%
6.Temesgen D et al282022EthiopiaRetrospective452235.1%
7.Otieno C et al162010KenyiaCross-sectional 471429.8%
8.Derse T et al192023EthiopiaCross-sectional 357143.9%
9.Mekonen G et al182022EthiopiaRetrospective387174.4%
10.Tekeste P et al292021EthiopiaRetrospective1531711.1%
11.Kakusa M et al132016ZambiaRetrospective8067.5%

Incidences of mortality among adult diabetes ketoacidosis patient

Diabetes ketoacidosis related-mortality among adult patients in East Africa ranges from 1.3%-47.8%. The random effects model analysis in this study revealed that the incidence of mortality among DKA patient in East Africa found to be 12.02% (95% CI: 5.99–18.04; I2 = 89.9%; p < 0.001) ( Figure 2). Subgroup analysis was conducted in the stratified study countries. The findings showed that the incidence of mortality among DKA found to be 8.18% (4.9, 11.46) in Ethiopia and 14.78 (13.1,42.6) in Kenya (Supplementary figure 1).

b5dbb1ee-f118-4b5b-8812-9631c9dc50aa_figure2.gif

Figure 2. Forest plot showing the pooled incidences of mortality among adult patients with diabetes ketoacidosis in East Africa.

Publication bias was assessed by visual inspection of the meta-funnel plot, which showed asymmetrical distribution (Supplementary figure 2). The Egger regression test revealed p < 0.0001, suggesting the presence of publication bias (Supplementary figure 3). Finally, a meta-trim-fill analysis was conducted, and no imputation was performed.

Sensitivity analysis: Furthermore, a leave-one-out sensitivity analysis was conducted to identify the potential source of heterogeneity in the incidence of mortality among adult DKA patients in East Africa. This sensitivity analysis demonstrated that the study does not depends on a single study. In conclusion, the mortality rate among adult patients with diabetic ketoacidosis are found to be 12.02% (95% CI: 5.99–18.04; I2 = 89.9%; p < 0.001).

Predictors of mortality among adult DKA patient

Several risk factors are significantly associated with treatment outcomes of diabetes ketoacidosis among patients with diabetes in East Africa. Different studies from East Africa have revealed that smoking, urinary tract infection, comorbidities, severe hypokalemia,20,29 inadequate potassium replacement, insulin administration error, sepsis, inappropriate fluid administration,15,19,29 age, severity of DKA,18 presence of renal failure, aspiration, altered mental status,13 severity of DKA, newly diagnosed diabetes,26,28,29 and presence of medical insurance,14 are factors contributing to diabetes ketoacidosis treatment outcomes.

Eight variables were selected for analysis in 11 studies. In this thesis, the presence of sepsis, comorbidities, potassium supplementation, and time of diabetes diagnosis were pooled. The pooled estimate of this systematic review and meta-analysis showed that the presence of sepsis and comorbidities was a significant predictor of mortality among adult patients with diabetes ketoacidosis. Patients with diabetes ketoacidosis who had any comorbidities had a higher mortality rate 2.15 (95% CI; 1.56, 2.74), than those DKA patients without any comorbidities (supplementary Figure 4). Additionally, the mortality rate was 1.77 (95% CI: 1.60, 1.95), greater for DKA patients with a sepsis diagnosis than for DKA patients without a sepsis diagnosis (Supplementary figure 5).

Discussion

Patients with DKA, receive appropriate care should recover fully in less than a day.30,31 Prolonged DKA occurrence results in thromboembolic problems, cerebral edema, cardiac arrhythmia, hypoglycemia, hypokalemia,32 renal failure, coma, cerebral edema, cardiac arrhythmia,33,34 lung edema with respiratory failure, and death.35,36 Recovery is associated with prompt diagnosis and timely initiation of DKA treatment. This, in turn, reduces hospital bed occupancy, the duration of hospital stay, and the quantity of material and human resources required to manage it and its complications.

The purpose of this systematic review and meta-analysis was to evaluate mortality and its predictors in adult patients with DKA. As a result, the pooled incidence DKA related mortality among diabetes patient was found to be 12.02%. The findings of this study were lower than study conducted in 25.9%.37 The possible reasons for this discrepancy might be differences in the subjects of the included studies. A previous systematic review and meta-analysis was conducted among DKA patients who were diagnosed with SARS-CoV-2,37 while in the current review, the study subjects were all DKA patients, regardless of their comorbidities. In fact, the presence of comorbidities such as SARS-CoV-2 worsens the treatment outcome of DKA.38–40 In addition, the authors did not rule out the possibility that mortality was due to DKA or SARS-CoV-2.

In this finding, the mortality of DKA among adult D. M was lower Compared to that study conducted in India (18.9%).41 The possible reasons for this discrepancy might be the differences in the study settings. In India, the study was conducted among DKA patients admitted to the ICU with and without NIV.41 The mortality of patients admitted to the ICU is higher than that of other inpatients.42

The current systematic review revealed that the mortality of DKA among adult patients was higher than the study conducted in Japan (3.3%).43 A possible reason for this discrepancy might be differences in socio-economic factors such as infrastructure, trained human power, and resources. Several factors predict DKA-related mortality in Africa, including availability of medical care, access to insulin, and other forms of treatment, in addition to social, cultural, and ethnic issues.11

The findings of this systematic review and meta-analysis revealed that comorbidities and the presence of sepsis were significant predictors of mortality among patients with diabetic ketoacidosis. Patients with diabetes ketoacidosis who had any comorbidities had a higher mortality rate than those with DKA without any comorbidities, which is consistent with the results of studies conducted in Kenya Nairobi26 and Jimma Ethiopia.44 A possible reason for this might be comorbid conditions such as heart disease and renal failure causing multi-organ dysfunction, as patients with both comorbidities and DKA had a higher risk of death.

Patients with diabetic ketoacidosis who were diagnosed with sepsis had a higher mortality rate than those with DKA without sepsis, which is supported by a study conducted in Kenya Nairobi,26 Jimma, Ethiopia,44 Addis Ababa, Ethiopia,19 Hiwot-fana, Ethiopia,29 and Saudi Arabia.45 This may be because sepsis results in the production of counter-regulatory hormones, such as adrenal and cortisol, which in turn decrease the effect of insulin on the regulation of glucose.46

Implication

These findings are of key importance to clinicians, hospital decision makers, and health policymakers. Prioritizing the early management of high-risk patients, ensuring adequate resources for sepsis and comorbidity management, and implementing standard care pathways can improve outcomes. The study also helps synthesize previous conflicting results, delivering a strengthened evidence base to inform clinical practice and regional health policies.

Conclusion

The cumulative mortality rate among patients with diabetic ketoacidosis in East Africa remains high. Sepsis and comorbidities are independent predictors of mortality and highlight the need for increased clinical suspicion in patients who present with these risk factors. Early identification and targeted treatment of comorbidities and sepsis are essential to prevent in-hospital mortality.

Strength and Limitation of the study

This systematic review and meta-analysis was conducted to draw conclusions by avoiding inconsistent findings. However, this systematic review and meta-analysis pooled only studies reporting odds and did not consider hazard ratio.

Data availability

All data used in this systematic review and meta-analysis are openly available in Zendo under a CC0 1.0 Universal license.

The data set includes full data extraction sheet with study characteristics, sample sizes, outcomes, and other variables used for pooling estimates on Mortality and its predictors in adult diabetic ketoacidosis patients in East Africa, along with the PRISMA checklist for this review. The data extraction dataset can be accessed at: https://doi.org/10.5281/zenodo.16917476.47

The PRISMA checklist for this review is also available at Zenodo: https://doi.org/10.5281/zenodo.1691803348

All supplementary files are available at https://doi.org/10.5281/zenodo.16932536 .49 This includes:

  • • Supplementary figure 1: Forest plot showing subgroup analysis of study stratified by study countries on incidences of mortality among DKA patient in East Africa.

  • • Supplementary figure 2: Meta funnel plot showing publication bias on studies incidences of mortality among adult DKA patient in East Africa.

  • • Supplementary figure 3: Meta bias, egger test showing publication bias on studies incidences of mortality among adult DKA patient in East Africa.

  • • Supplementary figure 4: Forest plot showing the presences of association between comorbidities and mortality of adult DKA East Africa.

  • • Supplementary figure 5: Forest plot showing the presences of association between sepsis and mortality of adult DKA East Africa.

  • • Supplementary table 1: Search strategies used for one of the data bases.

  • • Supplementary table 2: Quality of studies assessed with New Castle-Ottawa scale.

References

  • 1.  Saeedi P, Petersohn I, Salpea P, et al.: Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Res. Clin. Pract. 2019; 157: 107843. PubMed Abstract | Publisher Full Text
  • 2.  Corwell B, Knight B, Olivieri L, et al.: Current diagnosis and treatment of hyperglycemic emergencies. Emergency Medicine Clinics. 2014; 32(2): 437–452. Publisher Full Text
  • 3.  Gosmanov AR, Gosmanova EO, Dillard-Cannon E: Management of adult diabetic ketoacidosis. Diabetes Metab. Syndr. Obes.: Targets Ther. 2014; 7: 255–264. PubMed Abstract | Publisher Full Text | Free Full Text
  • 4.  Benoit SR, Zhang Y, Geiss LS, et al.: Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality—United States, 2000–2014. Morb. Mortal. Wkly Rep. 2018; 67(12): 362–365. PubMed Abstract | Publisher Full Text | Free Full Text
  • 5.  Wolfsdorf J, Glaser N, Sperling MA: Diabetic ketoacidosis in infants, children, and adolescents: a consensus statement from the American Diabetes Association. Diabetes Care. 2006; 29(5): 1150–1159. Publisher Full Text
  • 6.  Feleke Y, Enquselassie F: An assessment of the health care system for diabetes in Addis Ababa, Ethiopia. Ethiop. J. Health Dev. 2005; 19(3): 203–210.
  • 7.  Gudina EK, Amade ST, Tesfamichael FA, et al.: Assessment of quality of care given to diabetic patients at Jimma University Specialized Hospital diabetes follow-up clinic, Jimma, Ethiopia. BMC Endocr. Disord. 2011; 11(1): 1–9. PubMed Abstract | Publisher Full Text | Free Full Text
  • 8.  Adem A, Demis T, Feleke Y: Trend of diabetic admissions in Tikur Anbessa and St. Paul’s University Teaching Hospitals from January 2005-December 2009, Addis Ababa, Ethiopia. Ethiop. Med. J. 2011; 49(3): 231–238. PubMed Abstract
  • 9.  Temsegen S: Acute Management of Diabetic Ketoacidosis in Tikur Ambesa Hospital’s Adult Emergency department and medical wards. American International Health Alliance’s; 2012.
  • 10.  Worku D, Hamza L, Woldemichael K: Patterns of diabetic complications at jimma university specialized hospital, southwest ethiopia. Ethiop. J. Health Sci. 2010; 20(1): 33–39. PubMed Abstract | Publisher Full Text
  • 11.  Jamison DT: Disease and mortality in sub-Saharan Africa.2006.
  • 12.  Hamed ZSS, Gawaly AM, Abbas KM, et al.: Epidemiology of infection as a precipitating factor for diabetic ketoacidosis at Tanta University Hospital. Tanta Med. J. 2017; 45(2): 68. Publisher Full Text
  • 13.  Kakusa M, Kamanga B, Ngalamika O, et al.: Comatose and noncomatose adult diabetic ketoacidosis patients at the University Teaching Hospital, Zambia: Clinical profiles, risk factors, and mortality outcomes. Indian J. Endocrinol. Metab. 2016; 20(2): 199–205. PubMed Abstract | Publisher Full Text
  • 14.  Twagirumukiza FR: The epidemiology, risk factors and outcomes of hyperglycemic emergencies at university teaching hospital of Kigali in emergency department.2021.
  • 15.  Kassaye DA, Girsha WD, Guto GJ, et al.: Diabetic ketoacidosis treatment outcome and associated factors among adult patients admitted to medical wards of Adama Hospital Medical College, Oromia, Ethiopia. Am. J. Intern. Med. 2018; 6(2): 34–42.
  • 16.  Otieno C, Kayima J, Mbugua P, et al.: Prognostic factors in patients hospitalised with diabetic ketoacidosis at Kenyatta National Hospital, Nairobi. East Afr. Med. J. 2010; 87(2): 67–74.
  • 17.  Shaaron S: A study of predictors and factors affecting outcome in diabetic ketoacidosis patients. Thanjavur: Thanjavur Medical College; 2018.
  • 18.  Mekonnen GA, Gelaye KA, Gebreyohannes EA, et al.: Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study. PloS one. 2022; 17(4): e0264626. PubMed Abstract | Publisher Full Text | Free Full Text
  • 19.  Derse TK, Haile MT, Chamiso TM: Outcome of Diabetic Keto Acidosis Treatment and Associated Factors Among Adult Patients Admitted to Emergency and Medical Wards at St. Paul’s Hospital, Addis Ababa Ethiopia, 2023: A Cross-Sectional Study. Diabetes Metab. Syndr. Obes.: Targets Ther. 2023; 16: 3471–3480. PubMed Abstract | Publisher Full Text | Free Full Text
  • 20.  Taye GM, Bacha AJ, Taye FA, et al.: Diabetic Ketoacidosis Management and Treatment Outcome at Medical Ward of Shashemene Referral Hospital, Ethiopia: A Retrospective Study. Clin. Med. Insights Endocrinol. Diabetes. 2021; 14: 11795514211004957. PubMed Abstract | Publisher Full Text | Free Full Text
  • 21.  Jayashree M, Singhi S: Diabetic ketoacidosis predictors of outcome in a pediatric intensive care unit of a developing country. Pediatr. Crit. Care Med. 2004; 5(5): 427–433. PubMed Abstract | Publisher Full Text
  • 22.  Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372. Publisher Full Text
  • 23.  Abebe GK, Abate BB, Zemariam AB, et al.: Prevalence and associated factors of physical injuries among patients with epilepsy in Sub-Sharan Africa: A systematic review and meta-analysis. Epilepsy Behav. 2024; 161: 110099. PubMed Abstract | Publisher Full Text
  • 24.  Peterson J, Welch V, Losos M, et al.: The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2011; 2(1): 1–12.
  • 25.  Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50: 1088–1101. PubMed Abstract | Publisher Full Text
  • 26.  Sokwalla S, Shah J, Chauhan S, et al.: Clinical Presentation and Outcomes of Care in Adults with Diabetic Ketoacidosis Pre-COVID-19 and during-COVID-19 at a Tertiary. Kenya: Referral Hospital in Nairobi; 2023.
  • 27.  Iddi S, Francis B, Jaka HM, et al.: Clinical presentation and precipitating factors of diabetic ketoacidosis among patients admitted to intensive care unit at a tertiary hospital in Mwanza, Tanzania. Tanzan. J. Health Res. 2017; 19(1). Publisher Full Text
  • 28.  Temesgen D, Miskir Y, Dessie G, et al.: Time to Recovery from Diabetic Ketoacidosis and its Predictors among Adult Diabetic Ketoacidosis Patients in DEBRE MARKOS Referral Hospital, North West Ethiopia, 2021: Retrospective Cohort Study. medRxiv. 2022:2022.04. 12.22273779.
  • 29.  Asfaw TP, Binega MG, Asmamaw MA, et al.: Treatment Outcome and Predictors of Mortality among Adult Diabetic Patients Admitted with Hyperglycemic Crises at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia. East African Journal of Health and Biomedical Sciences. 2021; 5(2): 45–52.
  • 30.  Muneer M, Akbar I: Acute metabolic emergencies in diabetes: DKA, HHS and EDKA. Diabetes Res. Clin. Pract. 2021; 1307: 85–114. Publisher Full Text
  • 31.  Eledrisi MS, Elzouki A-N: Management of diabetic ketoacidosis in adults: A narrative review. Saudi J. Med. Med. Sci. 2020; 8(3): 165–173. PubMed Abstract | Publisher Full Text
  • 32.  Van den Berghe G, Kitabchi AE, Fisher JN: Hyperglycemic crises: diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). Acute Endocrinology: From Cause to Consequence. 2008; 119–147. Publisher Full Text
  • 33.  Moravej H, Ilkhanipour H, Seratishirazi Z, et al.: Outcome of patients with diabetic ketoacidosis in South of Iran. J. Endocrinol. Diabetes. 2017; 4(2): 1–6. Publisher Full Text
  • 34.  Ahuja W, Kumar N, Kumar S, et al.: Precipitating risk factors, clinical presentation, and outcome of diabetic ketoacidosis in patients with type 1 diabetes. Cureus. 2019; 11(5). Publisher Full Text
  • 35.  Dhatariya KK, Vellanki P: Treatment of diabetic ketoacidosis (DKA)/hyperglycemic hyperosmolar state (HHS): novel advances in the management of hyperglycemic crises (UK versus USA). Curr. Diab. Rep. 2017; 17: 1–7.
  • 36.  Gibb FW, Teoh WL, Graham J, et al.: Risk of death following admission to a UK hospital with diabetic ketoacidosis. Diabetologia. 2016; 59: 2082–2087. PubMed Abstract | Publisher Full Text | Free Full Text
  • 37.  Alhumaid S, Al Mutair A, Al Alawi Z, et al.: Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis. Diabetol. Metab. Syndr. 2021; 13(1): 1–22.
  • 38.  Papadopoulos VP, Koutroulos M-V, Zikoudi D-G, et al.: Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis. Diabetol. Int. 2021; 12: 445–459. PubMed Abstract | Publisher Full Text | Free Full Text
  • 39.  Pasquel FJ, Messler J, Booth R, et al.: Characteristics of and mortality associated with diabetic ketoacidosis among US patients hospitalized with or without COVID-19. JAMA Netw. Open. 2021; 4(3): e211091. PubMed Abstract | Publisher Full Text | Free Full Text
  • 40.  Stevens J, Bogun M, McMahon D, et al.: Diabetic ketoacidosis and mortality in COVID-19 infection. Diabetes Metab. 2021; 47(6): 101267. PubMed Abstract | Publisher Full Text | Free Full Text
  • 41.  George JT, Mishra AK, Iyadurai R: Correlation between the outcomes and severity of diabetic ketoacidosis: A retrospective pilot study. J. Family Med. Prim. Care. 2018; 7(4): 787–790. PubMed Abstract | Publisher Full Text | Free Full Text
  • 42.  Young MP, Gooder VJ, McBride K, et al.: Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity. J. Gen. Intern. Med. 2003; 18: 77–83. PubMed Abstract | Publisher Full Text | Free Full Text
  • 43.  Sato Y, Morita K, Okada A, et al.: Factors affecting in-hospital mortality of diabetic ketoacidosis patients: A retrospective cohort study. Diabetes Res. Clin. Pract. 2021; 171: 108588. PubMed Abstract | Publisher Full Text
  • 44.  Desse TA, Eshetie TC, Gudina EK: Predictors and treatment outcome of hyperglycemic emergencies at Jimma University Specialized Hospital, southwest Ethiopia. BMC. Res. Notes. 2015; 8(1): 1–8.
  • 45.  Alotaibi A, Aldoukhi A, Albdah B, et al.: Diabetic ketoacidosis treatment outcome and associated factors among adult patients admitted to the emergency department and medical wards at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Cureus. 2020; 12(8). Publisher Full Text
  • 46.  Otieno C, Kayima J, Omonge EO, et al.: Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review. East Afr. Med. J. 2005; 82(12). Publisher Full Text
  • 47.  Kibret AG e: Mortality and its predictors in Adult Diabetic ketoacidosis patients in East Africa, Systematic review and meta-analysis, Data extraction sheet. Zenodo. 2025. Publisher Full Text Reference Source
  • 48.  Kibret AG e: Mortality and its predictors in Adult Diabetic ketoacidosis patients in East Africa, Systematic review and meta-analysis. PRISMA checklist. Zenodo. 2025. Publisher Full Text
  • 49.  Abebe G, Muhamed A: Supplementary file for the study Mortality and its predictors in Adult Diabetic ketoacidosis patients in East Africa: A 2025 Systematic review and meta-analysis. Zenodo. 2025. Publisher Full Text

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 03 Sep 2025
Comment
Author details Author details
Competing interests
Grant information
Article Versions (1)
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
 - -
Citations
SEE MORE DETAILS
CITE
how to cite this article
Kibret Abebe G, Bishaw Aynalem Z, Meseret F et al. Mortality and its predictors in Adult Diabetic ketoacidosis patients in East Africa: A 2025 Systematic review and meta-analysis [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:864 (https://doi.org/10.12688/f1000research.169430.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status:
AWAITING PEER REVIEW
AWAITING PEER REVIEW
?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 03 Sep 2025
Comment

Open Peer Review

Reviewer Status

AWAITING PEER REVIEW

Comments on this article

All Comments(0)

Add a comment
Sign up for content alerts

Browse by related subjects

    Alongside their report, reviewers assign a status to the article:
    Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
    Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
    Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
    Sign In
    If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

    The email address should be the one you originally registered with F1000.
    Email address not valid, please try again

    You registered with F1000 via Google, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Google account password, please click here.

    You registered with F1000 via Facebook, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Facebook account password, please click here.

    Code not correct, please try again
    Email us for further assistance.
    Server error, please try again.