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. 2022 Jun;52(6):1002-1008.
doi: 10.1111/imj.15214. Epub 2022 May 31.

Diabetic ketoacidosis: a canary in the mine for mental health disorders?

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Diabetic ketoacidosis: a canary in the mine for mental health disorders?

Peter S Hamblin et al. Intern Med J. 2022 Jun.

Abstract

Background: Recurrent diabetic ketoacidosis (DKA) has been linked to mental health disorders, but less is known about single DKA episodes. Most studies are retrospective, lacking control groups.

Aims: To prospectively examine psychosocial factors in patients presenting with recurrent or single episode DKA and compare with people who have not had DKA.

Methods: Case-controlled study (consecutive adult DKA admissions April 2015 to December 2016) at Western Health, Melbourne. Data were prospectively collected regarding diagnosed mental health disorders, likely depression (Patient Health Questionnaire (PHQ-9)), diabetes distress (Problem Areas in Diabetes (PAID) questionnaire) and presence of adverse social factors. A control group without a history of DKA was also recruited.

Results: Of 123 patients admitted with DKA (164 consecutive episodes), 70 consented to participate and 73 age-matched Type 1 diabetes controls were recruited. Eleven (61%) of 18 with recurrent DKA had a diagnosed mental health disorder versus 8 (19%) of 42 in the single episode group (P = 0.016). The prevalence of likely depression using PHQ-9 was: recurrent 50%; single 40%; and controls 22% (recurrent vs controls, P = 0.036; single vs controls, P = 0.053). Severe diabetes distress (PAID) was present in 47% of recurrent and 34% of single episode DKA (P = 0.387). As a group, DKA patients had significantly more unemployment, illicit drug use and tobacco smoking, a lower level of formal education and less regular medical contact compared with controls.

Conclusions: Mental health disorders and adverse socioeconomic factors appear to be common in patients with DKA. The diagnosis of DKA presents an excellent opportunity to screen for depression and offer appropriate intervention.

Keywords: depression; diabetes distress; diabetic ketoacidosis; mental health; psychosocial.

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References

    1. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes. Diabetes Care 2001; 24: 1069-78.
    1. Barnard KD, Skinner TC, Peveler R. The prevalence of co-morbid depression in adults with type 1 diabetes: systematic literature review. Diabet Med 2006; 23: 445-8.
    1. Manarte LF, Dias S, Góis C, Boavida JM. Independent factors associated with depression in type 1 diabetes mellitus. Acta Diabetol 2010; 47: 201-7.
    1. Trief PM, Xing D, Foster NC, Maahs DM, Kittelsrud JM, Olson BA et al. Depression in adults in the T1D exchange clinic registry. Diabetes Care 2014; 37: 1563-72.
    1. Bradford AL, Crider CC, Xu X, Naqvi SH. Predictors of recurrent hospital admission for patients presenting with diabetic ketoacidosis and hyperglycemic hyperosmolar state. J Clin Med Res 2017; 9: 35-9.

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