Diabetes: Identifying complications early

The high incidence of childhood diabetic ketoacidosis in Saudi Arabia highlights the need for interventions to prevent this dangerous complication of type 1 diabetes.



An 11-year study exposed the high incidence of children with diabetic ketoacidosis (DKA) in Saudi Arabia, a life-threatening complication of uncontrolled diabetes. The study raises the need for more campaigns to raise awareness of type 1 diabetes mellitus (T1DM). 

Type 1 diabetes mellitus (T1DM) is one of the most common metabolic disorders affecting children. In people with T1DM, the body's immune system attacks and destroys the cells that produce insulin, so patients become dependent on life-long daily insulin injections to maintain their blood glucose levels. Unlike type 2 diabetes, which is often caused by an unhealthy lifestyle, the risk factors associated with T1DM are not fully understood, though genetics and autoimmune diseases seem to play a role.

DKA happens when an acute lack of insulin causes the body to use fat to release energy. It causes chemicals called ketones to be released into the blood, making it acidic. “This study sought to assess the incidence and severity of DKA in children with previously undiagnosed T1DM and explore the potential association with autoimmune conditions,” explains Adnan Al Shaikh, paediatric endocrinologist at King Abdulaziz Medical City, Jeddah, and KAIMRC researcher.

The incidence rate of T1DM has grown in Saudi Arabia over the last 40 years. According to the International Diabetes Association, there are more than 30 new cases of T1DM per 100,000 people in Saudi Arabia, compared with 2.5 in Oman or 22.3 in Kuwait. With 16,000-plus children with T1DM in Saudi Arabia, there is an urgent need to identify the reasons and to prevent complications, such as DKA, arising from the condition.

“DKA is the most common cause of diabetes-related deaths in children; understanding the factors associated with DKA could lead to interventions,” Al Shaikh says.

The study looked at 390 newly diagnosed T1DM patients between 2005-2015 in children ranging from 3 months to 17 years old. The incidence of DKA was 37.7%. “The DKA frequency in Saudi Arabia is similar to that reported in Kuwait and Oman, but higher than in Scandinavian countries, where T1DM is historically and genetically more prevalent than in the Middle East, and ranges around 20%,” says Al Shaikh.

Although they did not find differences in the incidence of DKA between sexes, the severity of DKA was higher among girls. Body mass index (BMI) was lower among patients presenting with DKA, suggesting that it could be a predictor of DKA.  

No significant association was found between DKA and thyroiditis or celiac disease, two autoimmune diseases previously associated with T1DM. “Further studies on the factors associated with DKA and increasing awareness among healthcare workers and parents of DKA as the initial presentation of T1DM will help reduce the short-term risks and long-term consequences of DKA,” Al Shaikh concludes.


  1. Al Shaikh, A. et al. Incidence of diabetic ketoacidosis in newly diagnosed type 1 diabetes children in western

    Saudi Arabia: 11-year experience. J Pediatr Endocrinol Metab 32, 857– 862 (2019). | article

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