Hare, Matthew J L

Deitch, Jessica M

Kang, Matthew J Y

Bach, Leon A

2020-05-02

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. To describe clinical, psychological and demographic factors in adults with diabetic ketoacidosis (DKA) and particularly those factors associated with recurrent admissions. 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. 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). 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. This article is protected by copyright. All rights reserved.

Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.. Menzies School of Health and Research, Darwin, Australia.. Endocrinology Department, Royal Darwin Hospital, Darwin, Australia..

Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia..

Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.. Alfred Mental & Addiction Health, Alfred Health, Melbourne, Australia..

Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.. Department of Medicine (Alfred), Monash University, Melbourne, Australia..

Internal medicine journal 2020-05-02

https://orcid.org/0000-0002-9364-3368

https://orcid.org/0000-0002-9062-1518

https://pubmed.ncbi.nlm.nih.gov/32358796/?otool=iaurydwlib

https://hdl.handle.net/10137/8351

Depression

Diabetes Complications

Diabetes Mellitus, Type 1

Diabetic Ketoacidosis

Illicit Drugs

Clinical, psychological and demographic factors in a contemporary adult cohort with diabetic ketoacidosis and type 1 diabetes.

Journal Article

Publication