title: Precipitating factors of diabetic ketoacidosis at a public hospital in a middle-income country.
abstract: OBJECTIVE
  To study precipitating factors of diabetic ketoacidosis (DKA) at a public hospital in a middle-income country.
  
  
  METHODS
  Eighty patients with type 1 diabetes who had an emergency hospitalization for DKA between January 2005 and March 2010 at a tertiary care teaching hospital in Southern Brazil were studied. Data were collected by reviewing medical records and telephone calls. Treatment non-adherence was defined as the precipitating factor if there was diet abuse or insulin therapy noncompliance without identifiable infection.
  
  
  RESULTS
  The mean age of patients was 26±13 years. The majority (91.5%) of the patients had unsatisfactory metabolic control before the hospitalization. The most common DKA precipitating factor was treatment non-adherence: 39% of cases when all patients were evaluated and 49% when only patients with previous type 1 diabetes diagnosis were analyzed. Comparison between patients with DKA precipitated by treatment non-adherence and by other causes showed that the former group had more episodes of previous DKA and more frequently reported insulin omission previous to DKA.
  
  
  CONCLUSIONS
  Treatment noncompliance is the leading precipitating factor of DKA in Southern Brazil. Further efforts to reduce the occurrence of DKA should focus on patients with prior reports and evidence of treatment non-adherence.
authors.affiliation: Postgraduate Program-Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2150, Porto Alegre, Brazil. leticiasweinert@yahoo.com.br
authors.forename: Letícia S
authors.initials: LS
authors.lastname: Weinert
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Scheffel
authors.forename: Mateus D
authors.initials: MD
authors.lastname: Severo
authors.forename: Alex P
authors.initials: AP
authors.lastname: Cioffi
authors.forename: Gabriela H
authors.initials: GH
authors.lastname: Teló
authors.forename: Artur
authors.initials: A
authors.lastname: Boschi
authors.forename: Beatriz D
authors.initials: BD
authors.lastname: Schaan
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D016883:Diabetic Ketoacidosis / Q000209:etiology*; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D010349:Patient Compliance; D015985:Precipitating Factors; D055815:Young Adult