| Summary: | Abstract Diabetic ketoacidosis (DKA) is a life-threatening hyperglycemic emergency with high morbidity and mortality in diabetes. This study explored determinants of diabetic ketoacidosis among adult diabetic patients in Ambo Town, Ethiopia. An unmatched case–control study was conducted from February 1 to March 30, 2024, involving 78 DKA cases and 230 controls (patients with diabetes mellitus and without DKA). Data were collected through structured questionnaires and chart reviews. Quality assurance measures included pretesting, data collector training, and supervision. Data were analyzed using SPSS version 25, with binary logistic regression identifying significant determinants, considering p < 0.05 as significant. The mean age of participants was 45.87 years (± 17.12 SD). Statistically significant determinants of DKA included being a type 1 diabetic [AOR 3.5; 95% CI 1.54–7.96], presence of comorbidities [AOR 4.82; 95% CI 2.03–11.42], irregular attendance at diabetic clinic appointments [AOR 6.14; 95% CI 2.25–14.7], discontinuation of prescribed medications [AOR 3.07; 95% CI 1.34–7.04], lack of health insurance [AOR 5.00; 95% CI 2.22–11.26] and other diabetes-related complications [AOR 4.25; 95% CI 1.59–11.3]. Therefore, Interventions should target follow-up care, medication adherence, insurance access, and comorbidity management to reduce risk and improve outcomes.
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