LIFESTYLE-RELATED DETERMINANTS OF DIABETIC KETOACIDOSIS: EPIDEMIOLOGICAL AND PUBLIC HEALTH INSIGHTS INTO E-CIGARETTE USE, ALCOHOL INTAKE, AND RECREATIONAL DRUG EXPOSURE

Daniel Oyedemi, Micheal Abimbola Oladosu*, Moses Adondua Abah, Elizabeth Okeoghene Alagba and Bukola Oluwaseyi Olufosoye

ABSTRACT

Diabetic ketoacidosis (DKA) represents a severe metabolic complication of diabetes mellitus with significant morbidity and mortality implications. While traditional risk factors such as insulin non-compliance and infection are well-established, emerging evidence suggests that lifestyle behaviours, particularly e-cigarette use, alcohol consumption, and recreational drug exposure, play increasingly important roles in DKA pathogenesis. This comprehensive review synthesises current epidemiological evidence on the relationships between these lifestyle determinants and the occurrence, severity, and outcomes of DKA. Recent studies demonstrate that e-cigarette use, especially among youth and young adults, contributes to metabolic derangements through oxidative stress, inflammatory responses, and direct pancreatic beta-cell toxicity. Alcohol consumption exhibits a complex dose-dependent relationship with DKA risk, where both acute intoxication and chronic use patterns influence metabolic control. Recreational drugs, including cannabis, cocaine, and synthetic cannabinoids, have emerged as significant DKA precipitants through multiple mechanisms including appetite suppression, insulin omission, and direct metabolic effects. This review presents epidemiological trends, mechanistic insights, and public health implications of these lifestyle factors. Understanding these relationships is crucial for developing targeted prevention strategies, improving risk stratification, and informing public health policies addressing the intersection of substance use and diabetes management.

Keywords: Diabetic ketoacidosis; E-cigarettes; Vaping; Alcohol consumption; Recreational drugs; Cannabis; Lifestyle factors; Public health; Epidemiology; Diabetes complications.