M. Al-Rasheedi, B. Ibrahim, KH. Haider, AA. Ali and H. Zainal (2026). Knowledge, attitude, and practice of physicians toward the management of diabetic ketoacidosis. Frontiers in clinical diabetes and healthcare, 7, 1723632. https://doi.org/10.3389/fcdhc.2026.1723632

PubMed 41717053

[Abstract]
BACKGROUND: Diabetic ketoacidosis (DKA) is a serious complication of uncontrolled diabetes that results from insufficient insulin, high blood sugar levels, dehydration, and disturbances in acid-base status in the blood. This condition can arise from infections or treatment errors, such as inadequate insulin dosing or missed doses, and affects both type 1 and type 2 diabetes.

AIM: The study aims to identify gaps in physicians' knowledge, attitudes, and practices (KAP) regarding the updated Diabetic Ketoacidosis protocol from the Ministry of Health (MoH) to enhance educational programs and improve patient outcomes.

PATIENTS AND METHODS: This cross-sectional study, conducted between July 2023 and July 2024, involved 242 physicians treating DKA across ten tertiary hospitals in five administrative regions of Saudi Arabia. Interns and physicians with less than one year of experience were excluded. Data were collected using a validated KAP questionnaire.

RESULTS: Among the 242 physicians surveyed, 57.9% demonstrated poor knowledge, 38.0% had fair knowledge, and only 4.1% exhibited good knowledge (Mean ± SD: 4.79 ± 1.85). Knowledge levels were significantly higher among females (p=0.001), physicians over 40 years of age (p<0.001), those with more than 15 years of experience (p<0.001), and endocrinologists (Mean ± SD: 6.25 ± 1.26, p<0.001). A favorable attitude was observed in 68.6% of physicians (Mean ± SD: 8.03 ± 1.81), significantly influenced by marital status (p=0.002). Good practices were noted in 51.7% of the physicians (Mean ± SD: 3.05 ± 1.84), with significant predictors including age, gender, experience, and region (p<0.05). The overall model explained 34.5% of the variability in knowledge, 16% of the variability in attitude, and 30.2% of the variability in practice.

CONCLUSION: This study highlights significant gaps in physicians' knowledge, attitudes, and practices regarding DKA management in Saudi Arabia. Younger, less experienced doctors tend to have lower knowledge scores, while higher scores are observed among endocrinologists and intensive care unit physicians, underscoring the need for targeted educational interventions.