Diabetic Ketoacidosis: Systematic Review and Meta‐Analysis
Authors' conclusion
Medication omission and infection remain the dominant precipitants of adult DKA worldwide. Marked variation in management practices and outcomes persists across healthcare systems, suggesting inconsistent implementation of DKA care pathways.
Study context
- Population
- Adults (≥ 16 years) with diabetic ketoacidosis (DKA), in studies reporting precipitating factors, management and outcomes, published from 2000 to April 2026Nineteen studies met the inclusion criteria · descriptive synthesis: 15 studies, DKA episodes 1,278 · mortality meta-analysis: nine studies, participants 724
- Outcome
- In-hospital all-cause mortality (summary estimate)
- Follow-up
- In-hospital
Methodological detailsrandom-effects meta-analysis, descriptive synthesis
- Random-effects meta-analysis
- Descriptive synthesis
Pooled result
As reported in the abstract
In-hospital mortality summary estimate
2.17%
95% CI 0.93%–4.99%
Further pooled results
DKA severity
- Most episodes were classified as moderate or severe DKA
Preadmission glycaemic control
- Preadmission glycaemic control was frequently suboptimal
Precipitants of DKA
- Missed or inadequate diabetes medication
- 42.2%
- Infection
- 28.6%
- Newly diagnosed diabetes
- 11.2%
Management and outcomes across regions
- Substantial regional variation was observed in guideline use, insulin and fluid administration, intensive care admission and treatment-related complications
Original publication
Diabetic Ketoacidosis: Systematic Review and Meta‐Analysis. Diabetes Obes Metab. Published 9 November 2026. doi:10.
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