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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2012.98asm-1-98LettersReply Alrashed Abdulaziz M. From the Department of Pediatrics, King Abdulaziz University, Hospital, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Abdulaziz M. Alrashed MD, PO Box 245, Riyadh 11411, Saudi Arabia, drarrashed@hotmail.comJan-Feb 2012 32 1 98 98 Copyright © 2012, Annals of Saudi Medicine2012This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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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.”
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REFERENCES
1 Abdullah MA   Epidemiology of type I diabetes mellitus among Arab children Saudi Med J 2005 26 911 7 15983673 
2 Salman H  Abanamy A  Ghassan B  Khalil M   Insulin dependent diabetes mellitus in children: Familial and clinical patterns in Riyadh Ann Saudi Med 1991 11 302 6 17588108