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Diabetic ketoacidosis: an overlooked child killer in sub-Saharan Africa?
1School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Insights
Diabetic ketoacidosis (DKA) is frequent in sub-Saharan Africa, especially in type 2 diabetes patients. Treatment must address concurrent infections and consider affordability, recommending integration with existing health programs.
Area of Science:
- Endocrinology and Metabolism
- Public Health
- Infectious Diseases
Background:
- Diabetic ketoacidosis (DKA) incidence is unknown in sub-Saharan Africa, but it uniquely affects type 2 diabetes patients of African origin.
- Hyperglycemia-induced osmotic diuresis, dehydration, and tissue hypoxia are key pathophysiological mechanisms.
- Complications include cerebral edema, exacerbated by malnutrition and prevalent infections like tuberculosis (TB) and HIV.
Purpose of the Study:
- To highlight the unique challenges and characteristics of DKA in sub-Saharan Africa.
- To emphasize the need for adapted treatment guidelines and integrated healthcare approaches.
Main Methods:
- Review of existing literature and clinical observations regarding DKA in the region.
- Analysis of factors contributing to DKA incidence, morbidity, and mortality.
Main Results:
- DKA is unusually common in type 2 diabetes in this population, unlike in Western countries.
- Overlapping symptoms with infections (TB, HIV) and malnutrition lead to misdiagnosis, increasing mortality.
- Affordability of insulin and use of alternative therapies complicate management.
Conclusions:
- Standard DKA treatment guidelines may not be suitable for the sub-Saharan African context.
- Screening for comorbidities in children and concurrent treatment for infections are crucial.
- Leveraging established programs like Expanded Immunization and TB/HIV/AIDS is recommended to support diabetes services.
Abstract:
The true incidence of diabetic ketoacidosis (DKA) in sub-Saharan Africa is unknown but unlike in the Western countries, DKA is also uniquely frequent among type 2 diabetes patients of African origin. Increased hyperglycaemia and hepatic ketogenesis lead to osmotic diuresis, dehydration and tissue hypoxia. Acute complications of DKA include cerebral oedema, which may be compounded by malnutrition, parasitic and microbial infections with rampant tuberculosis and HIV. Overlapping symptoms of these conditions and misdiagnosis of DKA contribute to increased morbidity and mortality. Inability of the patients to afford insulin treatment leads to poor glycemic control as some patients seek alternative treatment from traditional healers or use herbal remedies further complicating the disease process. Standard treatment guidelines for DKA currently used may not be ideal as they are adapted from those of the developed world. Children presenting with suspected DKA should be screened for comorbidities which may complicate fluid and electrolyte replacement therapy protocol. Patient rehabilitation should take into account concurrent treatment for infectious conditions to avoid possible life-threatening drug interactions. We recommend that health systems in sub-Saharan Africa leverage the Expanded Immunization Programme or TB/HIV/AIDS programmes, which are fairly well entrenched to support diabetes services.
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