Diabetic Ketoacidosis at the Onset of Pediatric Type 1 Diabetes Mellitus: Prevalence and Associated Factors in Southern Iran

Objectives: Diabetic ketoacidosis (DKA) is one of the most severe acute complications of type 1 diabetes mellitus (T1DM) and remains a major cause of mortality in the pediatric population. Early diagnosis of T1DM can prevent the occurrence of DKA; however, late diagnosis is still common in many areas. This study aimed to determine the prevalence of DKA as the first clinical manifestation of T1DM in children admitted to Bandar Abbas children’s hospital in 2024 and to investigate its association with demographic and clinical characteristics. Materials and Methods: This prospective, cross-sectional, descriptive-analytical study was conducted among 140 children and adolescents aged 6 months to 18 years with newly diagnosed T1DM. Data were collected using a checklist designed by the researcher and informed by medical records and clinical history. The variables studied included age, sex, duration of symptoms before diagnosis, severity of DKA, place of residence, parental education level, and clinical outcomes. DKA was diagnosed based on the criteria of the International Pediatric Endocrinology Association. Statistical analysis was performed using SPSS version 26, and statistical significance was defined as P < 0.05. Results: The mean age of the participants was 3.95 ± 8.94 years, and 51.4% of them were girls. DKA was observed in 80 patients (57.1%) as the initial manifestation of T1DM. In terms of severity, moderate DKA was the most common (38.8%), followed by severe (35.0%) and mild (26.2%). Patients with DKA had a longer duration of symptoms before diagnosis and were more often from rural areas. Also, younger age and lower maternal education level were associated with a higher prevalence of DKA. No mortality was observed in this study, and all patients recovered with appropriate treatment. Conclusions: The prevalence of DKA at the time of onset of T1DM in children in southern Iran is high. Late diagnosis, rural residence, younger age, and lower parental education are factors associated with increased incidence of DKA. These results emphasize the importance of public education and implementation of early diagnosis strategies to reduce the burden of DKA in children.