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Diabetic ketoacidosis continues to be an important cause of death among patients with type 1 diabetes. The average mortality rate for ketoacidosis today is quoted as between 5 and 10 per cent although rates vary widely. Experienced centres would expect to report a mortality rate of less than five per cent. Some deaths are inevitable consequences of associated medical conditions such as overwhelming infection. Clearly, the mortality associated with diabetic ketoacidosis has not been abolished, despite the ready availability of insulin, at least in Western countries. Mortality rates for diabetic ketoacidosis vary with prevailing socio-economic factors and the provision of general medical care.

• Developing countries. In Tanzania during the 1980s, for example, hospital mortality rates from ketoacidosis were reminiscent of those during the pre-insulin era in the West.

• Industrialised countries. Even in countries with well developed health care systems some deaths associated with ketoacidosis are potentially preventable, arising from factors such as o delays in presentation or diagnosis o errors in management, either by the patient on the part of medical attendants.

Differences in (1) the definition of ketoacidosis and (2) patient selection may also account for a proportion of this variation. Mortality need not be higher in non-university hospitals than in teaching centres if appropriate guidelines for management are implemented. Mortality is generally higher in certain groups of patients such as the very elderly.

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