Background and aim: Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. The evidence suggests that patient both, with type 1 and type 2 diabetes can develop DKA. The aim is to review the frequency, trend, provocative factors and outcome of DKA at our Clinic in period of 11 years.
Material and methods: We retrospectively reviewed the medical records of adult patients presenting DKA at Clinic of endocrinology, diabetes and metabolic disorders in Skopje, between January 1990 and December 1999. We classified these patients into 3 groups: type 1 diabetes, type 2 diabetes and new onset diabetes.

Results: 
We analyzed 318 patients presenting with an episode of DKA and they were divided into 3 groups: 110 with type 1 diabetes -age: 29.9 (14-51) years, M: 54 F: 56; 136 with type 2 diabetes -age: 56.1 (33-80) years, M: 71 F: 65; and 72 with new onset diabetes -age: 37.2 (16-75) years, M:39 F:33. Type 1 patients were younger and with significantly lower BMI than type 2 patients BMI=21.5 (15.4-48) vs. 23.5(15.7-39.2) kg/m2, p=0.0009. Trend of DKA episodes per year: 49 (1989), 36 (1990), 31(1991), 36 (1992), 32 (1993), 26 (1994), 26 (1995), 16 (1996), 21 (1997), 23 (1998), 22 (1999). The most frequent provocative factors for DKA were: discontinuation of insulin therapy 16.7% (25 in type 1, 16 in type 2 diabetes), acute upper respiratory tract infections 21.1% (25 in type 1, 27 in type 2 diabetes), urinary infections 16.3% (16 in type 1, 24 in type 2 diabetes), non-compliance with recommended treatment 10.6% (10 in type 1, 16 in type 2 diabetes), emotional stress 7% (7 in type 1, 10 in type 2 diabetes) and “unknown” reasons 28.3% (38 in type 1, 32 in type 2). The mortality rate from DKA among our patients was 20 (6.3%). 14 deaths can only be attributed to DKA alone (4.4%), and additional 6 patients died from DKA in association with cerebrovascular insult, myocardial infarction, acute pancreatitis and sepsis.

Conclusion:
In our study trend of DKA showed significant decreasing specially from 1994-1999. The most frequent provocative factors for DKA were discontinuation of insulin therapy, acute upper respiratory tract infections, urinary infections and non-compliance with recommended treatment. Mortality rate from DKA was 4.4%. More effort on patient education regarding sick day rules may prevent occurring of DKA.