Abstract
Background: Diabetic ketoacidosis (DKA) is a potentially life‐threatening but often preventable acute complication of type 1 diabetes (T1D). Understanding clinical and psychosocial characteristics of people with DKA, particularly those with multiple presentations, may aid the development of prevention strategies.
Aims: To describe clinical, psychological and demographic factors in adults with diabetic ketoacidosis (DKA) and particularly those factors associated with recurrent admissions.
Methods: A retrospective analysis was performed of all admissions with DKA in people with T1D over a 4‐year period from 1st November 2013 to 31st October 2017 at a metropolitan tertiary hospital in Australia. Potential cases were identified by ICD‐10 coding data. Data were then manually extracted by clinicians from the electronic medical record.
Results: There were 154 clinician‐adjudicated admissions for DKA among 128 people with T1D. Of these, 16 (13%) had multiple DKA admissions. Forty‐one (32%) had a history of depression. The most common factors contributing to presentation included insulin omission (54%), infection (31%), alcohol excess (26%) and new diabetes diagnosis (16%). Compared to people with single admissions, those with recurrent DKA were more likely to smoke (69% vs 27%, p = 0.003), be unemployed (31% vs 11%, p = 0.04) and use illicit substances (44% vs 17%, p = 0.02).
Conclusions: There is a high prevalence of psychiatric illness, illicit substance use and social disadvantage among people admitted with DKA, particularly those with recurrent presentations. Insulin omission, often due to inappropriate sick day management, was the most common reason for DKA occurrence. Innovative multidisciplinary models of care are required to address these challenges.
Aims: To describe clinical, psychological and demographic factors in adults with diabetic ketoacidosis (DKA) and particularly those factors associated with recurrent admissions.
Methods: A retrospective analysis was performed of all admissions with DKA in people with T1D over a 4‐year period from 1st November 2013 to 31st October 2017 at a metropolitan tertiary hospital in Australia. Potential cases were identified by ICD‐10 coding data. Data were then manually extracted by clinicians from the electronic medical record.
Results: There were 154 clinician‐adjudicated admissions for DKA among 128 people with T1D. Of these, 16 (13%) had multiple DKA admissions. Forty‐one (32%) had a history of depression. The most common factors contributing to presentation included insulin omission (54%), infection (31%), alcohol excess (26%) and new diabetes diagnosis (16%). Compared to people with single admissions, those with recurrent DKA were more likely to smoke (69% vs 27%, p = 0.003), be unemployed (31% vs 11%, p = 0.04) and use illicit substances (44% vs 17%, p = 0.02).
Conclusions: There is a high prevalence of psychiatric illness, illicit substance use and social disadvantage among people admitted with DKA, particularly those with recurrent presentations. Insulin omission, often due to inappropriate sick day management, was the most common reason for DKA occurrence. Innovative multidisciplinary models of care are required to address these challenges.
| Original language | English |
|---|---|
| Pages (from-to) | 1292-1297 |
| Number of pages | 6 |
| Journal | Internal Medicine Journal |
| Volume | 51 |
| Issue number | 8 |
| Early online date | 2 May 2020 |
| DOIs | |
| Publication status | Published - Aug 2021 |
Bibliographical note
Funding Information:M. J. L. Hare is supported by a NHMRC Postgraduate Scholarship, the Australian Academy of Science Douglas and Lola Douglas Scholarship, and the NHMRC/Diabetes Australia Postgraduate Award.
Publisher Copyright:
© 2020 Royal Australasian College of Physicians
