Decompensation Factors in Diabetic Ketoacidosis at the Fellah Polyclinic in Conakry, Guinea

Abstract

Diabetic ketoacidosis (DKA) is the most common and serious diabetic emergency, with a high mortality rate estimated between 5% and 21%. This study aimed to identify the factors contributing to DKA decompensation at the Fellah Polyclinic in Conakry, Guinea. A descriptive cross-sectional study with prospective data collection was conducted over a three-month period, from December 1, 2023, to February 29, 2024, at the Fellah Polyclinic, a national reference center for endocrine diseases. DKA was defined by the presence of fasting blood glucose ≥ 250 mg/dL, Kussmaul respiration, ketonemia ≥ 0.7 mmol/L, and glycosuria and acetonuria of at least two crosses. During the study period, 52 cases of DKA were identified among 120 hospitalized diabetic patients, representing a prevalence of 43%. The sex ratio was 0.73, favoring females. The mean age was 50.2 ± 16.2 years (range: 22 - 77 years). Type 2 diabetes was predominant (88.4%), and in 32.6% of cases, DKA was the initial presentation of the disease. All patients had blood glucose levels >400 mg/dL and ketonuria of at least two crosses. Notably, 50% of patients had not received any therapeutic education. The main decompensation factors identified were infection (71.1%), dietary errors (63.4%), treatment interruption (30.7%), inappropriate treatment (13.4%), and difficulties with insulin therapy (22%). Multiple factors were present in 30.7% of patients. DKA remains a frequent complication at the Fellah Polyclinic, where it often represents the first sign of type 2 diabetes. The primary decompensation factors—mainly infections, dietary mistakes, and challenges in treatment adherence—are largely preventable through targeted patient education and improved access to healthcare.