Assessment of Diabetic Ketoacidosis Awareness Among Diabetic Patients and Their Caregivers in Peshawar: A Cross-Sectional Study

Abstract

Background: Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes resulting from insulin deficiency, leading to hyperglycaemia, ketone formation, and metabolic acidosis. Both adult and paediatric guidelines emphasize early recognition of symptoms, adherence to sick-day rules, and ketone monitoring during illness or persistent hyperglycaemia to prevent severe outcomes..
Methods: It is a cross-sectional study carried out in outpatient diabetic clinics/medical outpatient departments of Combined Military Hospital (CMH), Peshawar. A total of 162 participants (patients and caregivers) were recruited through ]consecutive sampling. A structured interviewer-administered questionnaire measured knowledge of DKA definition/seriousness, triggers, symptoms, prevention, ketone testing, and first-response actions. A 20-item awareness score (0–20) categorized participants into poor, moderate, and good awareness. Associations were evaluated using chi-square tests and multivariable logistic regression.
Results: Among 162 respondents, 66.7% were patients and 33.3% were caregivers; 31.5% had good awareness. Major gaps were found in ketone testing knowledge (24.7%) and recognition of severe warning signs such as deep/rapid breathing (22.2%) and fruity breath (19.1%). Higher education, structured diabetes education, and prior DKA exposure were independent predictors of good awareness.
Conclusion: DKA awareness appears suboptimal in key actionable areas. Routine clinic-based education and improved access to ketone testing are recommended in Peshawar.