Reply

Thanks for asking me to react to the letter from Prof. M Al-Mendalawi. He stated that the frequency of DKA at diagnosis (49.9%) is still unacceptability high compared to the usual frequency of 20% to 25%. First of all he did not give a reference for this although he gave a references for other statements. Second, it is clearly stated in the results that previous studies gave a higher figure than this study (for example, the Abdullah and Salman studies).^1,2 Please see the quote from the results mentioned in the study:

“In the study by Salman et al, DKA was the most common clinical presentation and was observed in 74 (67.3%) patients; while in the present study, DKA was observed in 49.9% of the patients. In the study by Abdullah, 55% of the patients presented with DKA. Studies in Malaysia revealed a figure (48%) similar to that in the present study, while studies in Philippines and India revealed figures of 63% and 20% to 40%, respectively. [6],[21],[22] DKA is considered uncommon in Japan and Indonesia. [23],[24] DKA was observed in 49.9% of the patients in this series; thus DKA was less common in this study than in other local studies, such as those by Salman et al (DKA was observed in 67.2% of the patients) and Abdullah (DKA observed in 55% of the patients). This difference may be explained by a higher level of awareness among parents and improvement in health services with early diagnosis.”