Diabetic ketoacidosis at diagnosis of type 1 diabetes in the Middle East: a systematic review and meta-analysis

Abstract

Review title: Diabetic ketoacidosis at diagnosis of type 1 diabetes in the Middle East: a systematic review and meta-analysis Type and method of review: Meta analysis Stage of review at time of this submission: Review ongoing — the protocol has been finalised and the peer-reviewed search prepared; formal screening not yet started. Review question: In Children and adolescents with newly diagnosed type 1 diabetes in Middle Eastern countries, what is the effect of Diabetic ketoacidosis at diagnosis compared with None on Pooled proportion presenting with DKA at diagnosis; secondary: severe DKA and associated factors? Searches: The following sources will be searched: Europe PMC (PubMed, MEDLINE & preprints), PubMed / MEDLINE, Embase, Scopus, Web of Science Core Collection. Additional records may be imported from other databases. No date or language restrictions are applied unless otherwise stated. The search strategy underwent peer review (PRESS) before execution. Condition or domain being studied: Children and adolescents with newly diagnosed type 1 diabetes in Middle Eastern countries Participants / population: Children and adolescents with newly diagnosed type 1 diabetes in Middle Eastern countries Intervention(s), exposure(s): Diabetic ketoacidosis at diagnosis Comparator(s) / control: None Types of study to be included: Inclusion criteria: Children or adolescents with new-onset type 1 diabetes in Middle Eastern countries; DKA defined by stated biochemical criteria; Reports frequency of DKA at diagnosis or data allowing its calculation; Cross-sectional or cohort studies; Full-text article published in English. Exclusion criteria: Established type 1 diabetes only (DKA after diagnosis); Adult-only data; Reviews, editorials, letters or conference abstracts; Overlapping cohorts (the largest or most recent report is kept) Main outcome(s): Pooled proportion presenting with DKA at diagnosis; secondary: severe DKA and associated factors Data extraction (selection and coding): Two reviewers will independently screen titles/abstracts and full texts, blinded to each other’s decisions, and extract data in duplicate using a standardised, piloted form. Disagreements will be resolved by discussion or a third reviewer. Risk of bias (quality) assessment: The risk of bias of each included study will be assessed independently by two reviewers using a study-design-appropriate tool. Disagreements will be resolved by consensus. Risk of bias in the review itself will be appraised with ROBIS. Strategy for data synthesis: Results will be synthesised narratively. Where studies are sufficiently homogeneous, effect estimates will be pooled in a meta-analysis using a fixed- or random-effects model as indicated by heterogeneity (I²). The certainty of the evidence will be rated using GRADE.