Time to resolution of diabetic ketoacidosis in children with type 1 diabetes: a survival analysis of clinical predictors.

backgroundDiabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus in children, often leading to severe dehydration, altered consciousness, and death if not promptly managed. The burden of DKA is increasing globally and in Ethiopia, placing substantial strain on pediatric emergency and inpatient care services. Despite its clinical and public health importance, evidence on time to resolution of DKA and its predictors remains limited in Ethiopia, particularly in the northeastern region. This study aimed to assess the time to resolution of DKA and its predictors in children with type 1 diabetes.

methodsA retrospective follow-up study was conducted using 494 medical records of children with type 1 diabetes mellitus treated at Dessie Comprehensive Specialized Hospital between January 1, 2020, and December 31, 2024. Patient charts were selected using a simple random sampling technique. Data were extracted through a structured checklist based on registry and medical chart reviews. Kaplan-Meier survival analysis was employed to estimate time to resolution from DKA, and differences in survival distributions across categories of explanatory variables were assessed using the log-rank test. Cox proportional hazards regression was applied to identify predictors of time to resolution of DKA. Variables with a p-value < 0.25 in the bivariable analysis were included in the multivariable Cox regression model, adjusted hazard ratio (AHR) with its 95% confidence interval and p-value ≤ 0.05 in the multivariable analysis were considered statistically significant.

resultsA total of 487 children were followed for 12,279 person-hours of observation. Of these, 406 children recovered, yielding a resolution proportion of 83.37% (95% CI: 80.06-86.67), while 81 (16.63%) were censored during the follow-up period. The overall incidence rate of resolution from DKA was 3.30 per 100 person-hours (95% CI: 2.99-3.64), with a median time to resolution of 22 h (95% CI: 18.32-25.67). In the multivariable Cox regression analysis, baseline random blood sugar (RBS) levels > 500 mg/dL (AHR = 0.77; 95% CI: 0.62-0.96), presence of infection (AHR = 0.65; 95% CI: 0.47-0.90), newly diagnosed diabetes mellitus (AHR = 0.79; 95% CI: 0.63-0.99 and DKA duration ≥ 24 h (AHR = 0.08; inverse of < 24 h) were associated with a longer time to resolution of DKA. Conversely, mild DKA (AHR = 1.37; 95% CI: 1.01-1.84) and DKA duration < 24 h (AHR = 11.96; 95% CI: 7.71-18.55) were significantly associated with a shorter time to resolution of DKA. CONCLUSION AND RECOMMENDATIONS: The study identified a relatively prolonged resolution time of DKA among children in the study area. Baseline random blood sugar level > 500 mg/dL, presence of infection and newly diagnosed diabetes had negative relationship (delayed resolution) while mild DKA severity, and duration of DKA < 24 h had positive relationship (faster resolution). These findings highlight the need for healthcare providers and caregivers to address these factors to accelerate resolution and improve clinical outcomes.

trial registrationClinical trial number: Not applicable.