# Prevalence, Clinical Profile, and Outcomes of Diabetic Ketoacidosis (DKA) in Pediatric ICU Patients in the Middle East: A Systematic Review and Meta-Analysis

## TL;DR

This study reviews DKA in children in Middle Eastern ICUs, finding high severity but low mortality, with significant kidney issues.

## Contribution

The study provides the first synthesized evidence on DKA in pediatric ICU patients in the Middle East.

## Key findings

- Severe DKA (pH<7.1) was present in 37% of ICU admissions.
- New-onset type 1 diabetes accounted for 42.5% of DKA cases.
- Acute kidney injury affected 41.5% of patients in one cohort.

## Abstract

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) in children. While the global incidence is rising, data on the clinical profile and outcomes of pediatric DKA specifically within intensive care units (ICUs) in the Middle East remain fragmented. This systematic review and meta-analysis aimed to synthesize evidence on the prevalence, severity, and clinical outcomes of DKA in pediatric ICU settings across the region. PubMed, Embase, Scopus, Web of Science, and WHO Global Index Medicus were searched for observational studies published from January 2000 to December 2025. Studies were included if they reported on pediatric patients (0-18 years) with DKA admitted to ICUs in Middle Eastern countries. Two reviewers independently screened the studies, extracted data, and assessed their quality using the Joanna Briggs Institute (JBI) checklist and Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted to estimate the pooled prevalence and clinical parameters. Six studies comprising 919 pediatric patients from Saudi Arabia, Egypt, and Iran met the inclusion criteria. The pooled prevalence of severe DKA (pH<7.1) among ICU admissions was 37% (95% confidence interval (CI): 28%-46%), with substantial heterogeneity (I2=77.4%). New-onset T1DM accounted for 42.5% of cases. The pooled mean admission blood glucose was 445.4 mg/dL (95% CI: 367.3-523.6). Mortality was 0% (no deaths) across all included cohorts, and cerebral edema occurred in <1% of cases. However, acute kidney injury (AKI) was a significant morbidity, affecting 41.5% of patients in one prospective cohort. Pediatric DKA admissions to Middle Eastern ICUs are characterized by a high burden of severe metabolic acidosis and new-onset diabetes. Despite high disease severity, short-term survival is excellent, reflecting effective critical care management. The significant rate of AKI warrants increased vigilance. Standardized regional registries are needed to elucidate risk factors and long-term outcomes.