Introduction:

Diabetic ketoacidosis (DKA) is the most common acute complication of type 1 diabetes (T1D) requiring hospitalisation. Understanding factors contributing to these admissions is critical in implementing strategies and allocating resources to manage this high-risk population.

Methods:

From 1 April 2015 to 31 March 2016, data (demographics, social history and likely trigger(s) for the episode of DKA) were prospectively collected from all verbally consenting patients admitted with DKA under the Endocrinology Unit at Western Health. Patients were also invited to complete a Patient Health Questionnaire-9 (PHQ-9) to screen for depression, and a Problem Areas in Diabetes (PAID) Questionnaire to measure diabetes distress. De-identified data were entered into Excel for analysis.

Results:

There were 117 DKA admissions involving 94 patients in the 12-month study period. Of these, 72% were captured in the audit; 54% male; median[range] age 33[17-81] years; 40% unemployed; 47% smokers; and 25% self-reported current/past illicit drug use. Non-adherence to insulin therapy was the most common trigger for DKA (30% cases), followed by infection/gastrointestinal illness (15%), and new T1D diagnosis (14%).

71% of patients captured in the audit completed both the PHQ-9 and PAID questionnaires. Of these, 55% indicated minimal-mild depression, 41% moderate-severe depression, and 22% severe diabetes distress.

11 patients had repeated presentations for DKA (2 [2-5] presentations/12 months). More than half of these patients were unemployed, reported illicit drug use, and indicated moderate-severe depression or severe diabetes distress.

Conclusion:

The majority of patients hospitalised for DKA reported symptoms of depression, and a significant proportion reported diabetes distress, more so in those who had repeated admissions. Unemployment and illicit drug use were also prevalent. These factors likely contribute to poor diabetes self-management, forming a strong basis for the routine involvement of psychologists, social workers and addiction medicine specialists in the management of these patients.