Recurrent diabetic ketoacidosis

Abstract

Objective: The purpose of this study is to examine risk factors for recurrence of diabetic ketoacidosis and determine interventions to prevent future admissions. Materials and methods: Review article. Results: Recurrent diabetic ketoacidosis is a serious and not uncommon health problem. Diabetic ketoacidosis is associated with severe morbidity and mortality and hospital admissions due to this problem constitute a serious economic burden on the healthcare system. Younger age at diabetic ketoacidosis onset, poor baseline glycemic control and elevated HbA1C, patient comorbidities, depression, alcohol or substance abuse, particularly active cocaine use, have been associated with recurrent diabetic ketoacidosis. In addition, socioeconomic factors (such as ethnic minority status, use of public health insurance and underinsurance), psychosocial, economic, and behavioral factors (including financial constraint, stretching a limited insulin supply, and homelessness) have been all reported to be associated with readmission among diabetic ketoacidosis patients. Conclusions: Identifying high-risk patients during the first diabetic ketoacidosis admission and performing relevant interventions (repeated instructions of insulin use, social help and involvement of family members in medical treatment, collaboration with the patient's primary care physician in order to establish a close and frequent follow up program) may help prevent future admissions. Further studies need to take place to determine whether early interventions with those factors prevent future admissions.

Fatores que predispõem a cetoacidose diabética em adolescentes

“…Fazeli Farsani et al (2017) afirmam que a baixa aceitação, do indivíduo com diabetes mellitus insulino-dependente, ao tratamento com insulina é um fator predisponente para episódios de Cetoacidose diabética. Segundo o estudo de (Brandstaetter, Bartal, Sagy, Jotkowitz, & Barski, 2019) Há fragilidade no atendimento as complicações agudas do DM, como a dificuldade de acesso venoso, principalmente em idosos que além, de muitas vezes, apresentar uma rede venosa de difícil acesso também podem ter um histórico de diversas internações anteriores, que dificulta por parte da enfermagem uma assistência mais rápida (Oliveira, Schoeller, Hammerschmidt, Silva, & Arruda, 2016). Segundo a Sociedade Brasileira de Diabetes [SBD] (2019), a atuação de uma equipe treinada no controle glicêmico hospitalar é capaz de diminuir o tempo de internação, o índice de acontecimentos adversos, manter positivamente um controle da glicemia, reduzir o número de readmissão hospitalar e as despesas hospitalares.…”

Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: Results from the DPV initiative

“…Many studies have shown an association of DKA with psychiatric comorbidity and substance abuse in adults and children 24,30,39‐43 . DKA frequency is significantly increased in girls with T1D and eating disorders 44 .…”

Frequency of Diabetic Ketoacidosis in Patients with Type 1 Diabetes Using FreeStyle Libre: A Retrospective Chart Review

“…Arabia also demonstrated an increase in mean frequency of blood glucose testing following 3 months of FreeStyle Libre use in 95 patients with T1DM, from 2.5 times per day (SD 0.9) at baseline to 5.2 times per day (SD 1.2) at 3 months (p \ 0.001) [16]. Therefore, the use of FreeStyle Libre is a further tool for reducing the recurrence of DKA in addition to interventions such as intensive diabetes management [10], psychosocial and educational approaches [30], regular follow-up, and participation of family members in a patient's diabetes management [31].…”

“…Therefore, the use of FreeStyle Libre is a further tool for reducing the recurrence of DKA in addition to interventions such as intensive diabetes management [ 10 ], psychosocial and educational approaches [ 30 ], regular follow-up, and participation of family members in a patient’s diabetes management [ 31 ].…”