Background: Diabetic ketoacidosis is one of the most common fatal acute metabolic complications of diabetes mellitus. It is characterized by hyperglycemia, ketoacidosis, and ketonuria. In Africa, the prevalence of diabetic ketoacidosis has dramatically increased, affecting both genders equally in urban and rural settings. However, little is known about the risk factors of diabetic ketoacidosis in the study area. Hence, the aim of this study was to identify the risk factors that contribute to the development of diabetic ketoacidosis. Objective: To identify the risk factors of diabetic ketoacidosis among diabetes mellitus patients in East Gojjam zone public hospitals, North West Ethiopia, 2023. Method: Unmatched case-control study was conducted among 408 participants from March 15th to May 10th, 2023, in five randomly selected public hospitals in East Gojjam zone, North West Ethiopia. A systematic random sampling technique was used to select study participants. Primary data was collected using interviewer-administered questionnaires, and secondary data was collected with a checklist. The data was entered using Epi-Data version 3.1 and exported to SPSS version 25 for analysis. Logistic regression model was used to identify variables with significant associations at p-values < 0.05 with a 95% confidence interval. Results: A total of 102 cases and 306 controls (ratio of 1:3) participated in this study, with a response rate of 100%. In the study, absence of regular follow-up in the diabetes clinic [AOR = 2.21, 95% CI (1.31-3.71)], not being a member of community-based health insurance [AOR = 3.30, 95% CI (1.75-6.24)], distance from the health institution that is > 5km [AOR=1.85,95% CI (1.09-3.14)], infection [AOR = 2.15, 95% CI (1.12-3.89)], and decreasing the dose of insulin [(AOR = 2.13, 95% CI 1.19–3.83)] were identified as risk factors of diabetic ketoacidosis. Conclusion and recommendation: The study identified important risk factors for diabetic ketoacidosis. Absence of regular follow-up, not being a member of community-based health insurance, distance from the health institution, decreasing the dose of insulin and history of infection had a significant association with diabetic ketoacidosis. Therefore, healthcare providers should intervene based on the identified risk factors for diabetic ketoacidosis. Key words: Diabetic ketoacidosis, East Gojjam Zone, Hospitals, Risk factors