Awareness of Diabetic Ketoacidosis and Associated Factors Among Adults with Diabetes or a Family Member with Diabetes in Jazan, Saudi Arabia

Background: Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus that requires prompt recognition and timely management to reduce morbidity and mortality. Public awareness of DKA remains suboptimal in many settings, particularly among individuals with direct exposure to diabetes. This study aimed to assess DKA awareness and identify factors associated with appropriate DKA awareness among adults with personal or familial exposure to diabetes in the Jazan region of Saudi Arabia. Methods: A cross-sectional online survey was conducted among adults in the Jazan region between October 2024 and May 2025. Respondents with a personal diagnosis of diabetes or a family member diagnosed with diabetes were included. The questionnaire assessed sociodemographic characteristics, reported diabetes-related characteristics, and DKA awareness across multiple domains, including disease recognition, risk factors, precipitating factors, complications, prevention, and emergency management. Awareness was evaluated using a predefined scoring system, with scores ≥ 6/10 (≥60% of the maximum score) classified as appropriate DKA awareness. Factors associated with appropriate awareness were examined using chi-square tests and multivariable logistic regression. Results: A total of 417 respondents were included in the analysis, of whom 150 (36.0%) reported a personal diagnosis of diabetes and 267 (64.0%) reported having a family member with diabetes. Overall, 138 respondents (33.1%; 95% CI, 28.7–37.7%) demonstrated appropriate DKA awareness. Awareness varied across individual domains, with particularly limited recognition of DKA precipitating factors and preventive measures. In multivariable logistic regression analysis, age < 45 years (adjusted odds ratio [aOR] = 3.08, 95% CI: 1.47–6.48; p = 0.003), student status (aOR = 2.40, 95% CI: 1.18–4.90; p = 0.016), monthly household income > 15,000 SAR (aOR = 4.14, 95% CI: 1.83–9.37; p = 0.001), and a personal diagnosis of diabetes (aOR = 2.20, 95% CI: 1.29–3.75; p = 0.004) were independently associated with higher odds of appropriate DKA awareness. Reporting type 1 or type 2 diabetes, compared with an unknown diabetes type, was also independently associated with appropriate awareness. Educational attainment was not independently associated with awareness after multivariable adjustment. Conclusions: Overall DKA awareness among adults with personal or familial exposure to diabetes in the Jazan region was suboptimal. Appropriate DKA awareness was independently associated with younger age, student status, higher household income, and respondent relationship to diabetes. The association with reported diabetes type should be interpreted cautiously, as it may reflect greater familiarity with diabetes rather than an effect of diabetes subtype itself. These findings support the implementation of targeted educational strategies that include both individuals living with diabetes and their family members to improve recognition of DKA and promote timely healthcare seeking during acute diabetic emergencies. However, the findings should be interpreted in light of the non-probability, social-media-based recruitment strategy, which may have disproportionately represented younger and more highly educated individuals and limits population-level generalizability.