Meta-analysisindependent cross-checkabstract checked★ key study I-INS-114 in-depth review
Children with ketoacidosis in Middle Eastern intensive care units
Prevalence, Clinical Profile, and Outcomes of Diabetic Ketoacidosis (DKA) in Pediatric ICU Patients in the Middle East: A Systematic Review and Meta-Analysis.
Overview
Ali NM et al.. Cureus 2026 · PMID 41859577 · DOI 10.7759/cureus.103735
More than a third had severe ketoacidosis, but none died with intensive-care treatment.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Summarise paediatric DKA outcomes in Middle Eastern ICUs.
- How was the study done?
Systematic review of 6 studies.
- How many people, animals or samples were studied?
919 children (Saudi Arabia, Egypt, Iran).
- What was actually found?
37% severe; 0 deaths with ICU care; frequent kidney injury.
- How large was the observed effect?
Mortality 0% (upper bound about 0.4%).
- What do the results mean in everyday life?
Ketoacidosis is survivable when treated promptly in hospital.
- What are the study's limitations?
Small, low-quality evidence.
- What does it say about Elawady's specific claim?
Partly explains 'I never saw anyone die' but only for treated DKA.
- Do the results apply to Germany and Europe?
Similar to European results.
- What can explicitly not be concluded from this study?
Cannot show what happens without treatment.
Scientific in-depth review
1. Full reference
- Authors
- Ali NM et al.
- Journal
- Cureus
- Year
- 2026
- Identifier
- PMID 41859577 DOI 10.7759/cureus.103735
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
No funding (record).
2. Research question
What are severity and outcomes of paediatric DKA in Middle Eastern ICUs?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and random-effects meta-analysis of observational studies
- Population
Children 0-18 with DKA in ICUs
- Country
Saudi Arabia, Egypt, Iran
- Period
Studies 2000-2025
- Sample size
6 studies, 919 patients
- Inclusion and exclusion criteria
Observational ICU studies in the Middle East
4. Methods and endpoints
- Exposure / intervention
DKA (treated in ICU)
- Comparator
None
- Endpoints
Severity, mortality, cerebral oedema, AKI
- Statistical methods
Random-effects meta-analysis; JBI/NOS quality
5. Actual results
- Results
Severe DKA (pH <7.1) 37% (95% CI 28-46%; I2 77.4%); new-onset T1D 42.5%; mortality 0% in all cohorts; cerebral oedema <1%; acute kidney injury 41.5% in one cohort.
- Absolute risks
not reported
- Authors' conclusion
Despite high severity, short-term survival with ICU care is excellent; AKI warrants vigilance.
6. Strengths
- Regional (includes Egypt)
- Duplicate screening
7. Weaknesses
- Few, small observational studies
- Published in a journal with light peer review
- ICU-treated patients only (survivor/referral bias)
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- high
- Rationale
Low confidence; small evidence base; heterogeneity.
9. Assessment of the statistical interpretation
Pooled proportions; zero deaths among 919 treated children gives an upper 95% bound of about 0.4% (rule of three: 3/919).
10. Relevance to the specific claim
Shows that with insulin, fluids and ICU care, children with severe DKA in the region survive; this explains why a clinician may 'never see anyone die' of treated DKA, but it does not show that untreated DKA is harmless.
11. Independent contrary findings
12. Transferability to Germany and Europe
Similar to European outcomes for treated paediatric DKA.
13. Overall methodological judgement
Low-quality but regionally relevant; supports treatment, not its omission.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | high |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |