Psychosocial factors associated with repeat diabetic ketoacidosis in people living with type 1 diabetes: A systematic review

Allcock, Bethan; Stewart, Rose; Jackson, Mike

doi:10.1111/dme.14663

Cited by 7 publications

(7 citation statements)

References 73 publications

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“…Recurrent admissions for individuals could not be identified in this study but it is likely that some patients contributed more than one AI/AC admission. In the more common endocrine emergency, DKA, clinical experience, together with evidence from a recent meta-analysis, suggests that psychosocial factors appear to account for more frequent hospital presentations in some patients ( 21 – 23 ). In Australia, DKA incidence is highest among 15-19 year old females and, in the young adult age group, there is a female predominance at a ratio of 1·4:1 to males ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…In Australia, DKA incidence is highest among 15-19 year old females and, in the young adult age group, there is a female predominance at a ratio of 1·4:1 to males ( 22 ). DKA is also more common in lower socioeconomic groups ( 21 , 22 ). Overall, about 40% of cases of DKA are thought to be due to non-adherence with the treatment regimen ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

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Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

et al. 2022

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BackgroundVery little is known about the epidemiology of adrenal crises (AC) and adrenal insufficiency (AI) in adolescents and young adults.MethodsData on all admissions to Australian hospitals between 2000/1 to 2019/20 for a principal diagnosis of AI (including AC) in 10-24 year olds were extracted from a national repository. Age and sex-specific rates and age-adjusted rates were compared.FindingsOver the study, there were 3386 admissions for a principal diagnosis of AI; 24.0% (n=812) were for an AC and 50·7% (n=1718) were for secondary AI. Age-adjusted AI admissions increased from 31·70/million in 2000/1 to 54·68/million in 2019/20 (p<0·0001). Age-adjusted AC admissions also increased, most notably in the second decade (from 5·80/million in 2010/11 to 15·75/million in 2019/20) (p<0·00001). Average AI and AC admission rates were comparable between the sexes, but rates increased significantly in females, especially in those aged 20 to 24 years, whose AC rate in 2019/20 (39·65/million) was significantly higher than the corresponding rate in 2000/1 (3·15/million) (p<0·00001). Average age-adjusted SAI admission rates were higher in males (23·92/million) than females (15·47/million) (p<0·00001). However, SAI admission rates increased only among females (from 11·81/million to 22·12/million in 2019/20), with an increase in 20-24 year old females in the second decade from 5·07/million in 2010 to 20·42/million (p<0·00001). Age adjusted admissions for congenital adrenal hyperplasia, primary AI (PAI) and drug-induced AI did not change significantly over the study.InterpretationAC/AI admissions increased over the first two decades of this century in the emerging adult population, particularly among females who also experienced a marked increase in AC admission rates, most evident in the second decade. Although uncertain, possible explanations include: dose of glucocorticoid replacement; non-adherence to therapy; psychosocial factors; and difficulty in transition to adult services. Admissions for SAI also increased, while rates of PAI and CAH remained constant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

et al. 2022

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“…This finding is consistent with those of previous studies. According to a systematic review, 11 studies have concluded that women were more commonly affected by DKA compared to men, regardless of age, and three studies found the opposite result [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our study was the first to note these differences, as no significant evidence is found in other studies. However, many studies have observed that the prevalence of DKA is higher in females than in males [ 21 ]. Another study also suggested that the length of stay for men and women remained the same [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

An Audit of Factors Impacting the Time to Resolution of the Metabolic Parameters in Diabetic Ketoacidosis Patients

AlWahbi¹,

Alharbi²,

Almesned³

et al. 2022

Cureus

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Introduction: Diabetic ketoacidosis (DKA) is a major complication affecting patients with diabetes. It is often the first presentation of type I diabetes and can also occur due to a lack of compliance with insulin therapy or infection, among other causes. Hospitalizations for DKA have increased globally among patients with type I and type II diabetes, which poses a strain on health systems.Aim: To determine the factors impacting the time to resolution of metabolic parameters in DKA patients.Methods: This retrospective study was performed by reviewing the clinical records of hospitalized DKA patients at King Fahad Specialist Hospital, a tertiary-level healthcare center in Buraidah, Al Qassim region, Saudi Arabia. The study included all DKA admissions that met the inclusion criteria between September 2019 and April 2022.Results: A total of 129 patients with a diagnosis of DKA from January 2019 to April 2022 were identified. Of these, 67 patients met the inclusion criteria. More females experienced DKA (56.7%), and the study population had an improvement rate of 97%. The mean length of stay (LOS) for patients with DKA was 73.19 hours, and the median time for DKA resolution was 15 hours (mean time 21.38 hours). The omission of insulin was the leading precipitating factor for DKA (43%) followed by infection (12%). A high serum bicarbonate (HCO 3) level was identified as an independent predictor for a longer time to resolution. Patients with DKA who have high glucose levels on admission, higher body mass index (BMI), older age, and higher weight stayed in the hospital for extended periods. Conversely, patients with a higher serum potential of Hydrogen (pH) had a shorter LOS. Age was the only clinically independent predictor for a minimum LOS for DKA. Patients with comorbidities had a longer hospital LOS than patients without comorbidities; no such relationship has been reported in other studies. Patients in our study population had a longer time of resolution than observed in other studies, although no clear cause was identified.Conclusion: This study contributes to our understanding of DKA in hospitalized patients in Saudi Arabia. This is the first study to link patients with DKA who have comorbidities to a longer hospital stay in the kingdom of Saudi Arabia. This study also identified multiple clinical and biochemical parameters related to the variability in LOS and time to resolution of DKA in hospitalized patients Categories: Endocrinology/Diabetes/Metabolism

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“…There are disparities in occurrence of DKA, in that patients from disadvantaged socioeconomic backgrounds or with poor mental health have a higher incidence rates of DKA ( 7 , 8 ). Although management of diabetes and its associated complications has significantly improved over the past decades ( 9 , 10 ), DKA remains a significant health burden with high morbidity ( 11 ), mortality ( 12 – 14 ), and relevant utilization of health-care resources ( 15 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

et al. 2022

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ObjectiveDiabetic ketoacidosis (DKA) is a life-threatening complication of both type 1 and type 2 diabetes. We aimed to assess population-based rates, trends and outcomes of patients with DKA.Design and methodsThis is a nationwide cohort study using hospital discharge claims data from 2010 to 2018 in Switzerland. Incidence rates and in-hospital outcomes of DKA were analyzed throughout lifetime for children (0-9 years), adolescents (10-19 years), and adults (20-29, 30-59, and 60-90 years). Analyses were stratified for type of diabetes mellitus and sex.ResultsIn total, 5,544 hospitalizations with DKA were identified, of whom 3,847 were seen in patients with type 1 diabetes and 1,697 in type 2 diabetes. Incidence rates of DKA among patients with type 1 diabetes were highest during adolescence with 17.67 (girls) and 13.87 (boys) events per 100,000 person-years (incidence rate difference [IRD]: -3.80 [95% CI, -5.59 to -2.02]) and decreased with age in both sexes thereafter. Incidence rates of DKA in patients with type 2 diabetes were low up to an age of 40 years and rose to 5.26 (females) and 6.82 (males) per 100,000 person-years in adults aged 60-90 years. Diabetic ketoacidosis was associated with relevant health-care burden independent of age, sex, or type of diabetes. The population-based incidence rate of DKA increased over time from 7.22 per 100,000 person-years in 2010 to 9.49 per 100,000 person-years in 2018.ConclusionsIn type 1 diabetes highest incidence rates of DKA hospitalizations were observed among adolescent females. In comparison, in patients with type 2 diabetes the risk for DKA steadily increased with age with higher rates in adult males. Over the 9 year study period, incidence rates of DKA were increasing irrespective of type of diabetes. DKA was associated with a high burden of disease reflected by high rates of intensive care unit admission, prolonged hospital stay and high mortality rates, especially in elderly.

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Psychosocial factors associated with repeat diabetic ketoacidosis in people living with type 1 diabetes: A systematic review

Cited by 7 publications

References 73 publications

Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

An Audit of Factors Impacting the Time to Resolution of the Metabolic Parameters in Diabetic Ketoacidosis Patients

Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

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