Pattern, Severity, Precipitating Factors, and Outcome of Diabetic Ketoacidosis in People Admitted to Libyan Hospitals: A Systematic Review and Meta-Analysis

Abstract This study synthesized evidence about the prevalence, severity, precipitating factors, and mortality rate of diabetic ketoacidosis (DKA) in Libyan hospitalized patients with diabetes mellitus (DM). A systematic search of PubMed, ScienceDirect, Semantic Scholar, WHO Global Index Medicus, ALManhal, and Google Scholar was conducted to retrieve research articles addressing DKA in Libya. The quality of included studies was evaluated using the JBI checklist. Data extraction and sorting were performed in Microsoft Excel before exporting it to R (version 4.4.1) for analysis. A Der Simonian random-effects model was employed to calculate the pooled estimates for all variables. Publication bias and heterogeneity were assessed using the Egger's test and I 2 statistic. Subgroup analyses by diabetes type and age category were used to explore the potential sources of heterogeneity. Statistical significance was defined as p-values below 0.05. We identified 995 articles, 11 of which were included in this study. These 11 articles contained quantitative information of approximately 2,385 DKA cases from 8,509 hospitalized patients' records with DM. The available evidence indicated that the overall prevalence of DKA was 21.9% (95% CI 12.1–36.3; I 2 = 99%). Significant heterogeneity was observed (I 2 = 99%; p <0.01), though Egger's test suggested no significant publication bias (t = -2.00, df = 8, p = 0.08). Subgroup analyses showed a higher prevalence rate in Type 1 DM (65.2%) compared with Type 2 DM (3%), and in children (49%) compared with adults (17.0%), with only a slight reduction in heterogeneity (I 2> 97%). The pooled mortality rate was 5.7% (95% CI 1.6–11.7; I 2 = 94%). Moderate DKA was the most common severity (44%; 95% CI 32.0–56.5; I 2 = 96%), while the primary identified precipitating factors were omission of insulin (32.6%) and infections (22%). DKA prevalence in Libya is substantial and varies by age and type of DM. While the mortality rate is relatively low, targeted interventions focusing on patient education, insulin adherence, and infection control are essential to reduce the burden of DKA in the Libyan healthcare system.