Risk factors for recurrent admissions with diabetic ketoacidosis: importance of mental health

Recurrent hospitalizations for severe hypoglycemia and hyperglycemia among U.S. adults with diabetes

“…We could not capture the duration of diabetes (though presence of multiple diabetes complications ascertained using the DCSI may be a surrogate for longer duration of disease) as well as important social determinants of health and mental health conditions, which impact the likelihood of hypoglycemia 23,25–27 and hyperglycemia hospitalizations. 23,28,29 Our study relied on claims data of commercially-insured and Medicare Advantage beneficiaries, and patients with other or no healthcare coverage may face different medical, social, and economic challenges affecting their dysglycemia and readmission risks. Finally, while we could not assess the impact of glycemic control on readmission risk, HbA 1c was not previously shown to be a reliable discriminating risk factor between hypoglycemic and hyperglycemic events.…”

“…22 Severe hyperglycemia is more common among younger patients 21 and patients with depression or substance use. 24,45 Elevated hemoglobin A 1c (HbA 1c ) 1123,24 and socioeconomic disadvantage 23,25–29 are associated with both hypoglycemia and hyperglycemia. However, there is little information about recurrent hospitalizations for severe dysglycemia among adults with diabetes.…”

The Long-Term Incidence of Hospitalization for Ketoacidosis in Adults with Established T1D—A Prospective Cohort Study

“…Fiftly, we have no measures of compliance and mental health which may both influence glucose control and the risk for DKA (22)(23)(24). Finally, FinnDiane is an enriched cohort of adults with T1D who have volunteered to take part in this project.…”

Provision of continuous subcutaneous insulin infusion to type 1 diabetes ‘frequent flyers’

“…There is now evidence to suggest that CSII in young patients with poorly controlled diabetes may reduce hospital admissions and hypoglycaemic events 6 . Similarly, in adults with type 1 diabetes who were frequently admitted to hospital (frequent flyers), a clinical programme providing case management, mental health support and technology as required, was associated with improvements in glycaemia and reduced re‐hospitalisation 7,8 . In South Western Sydney, a recent audit demonstrated lower rates of appointment attendance and poorer glucose control among those with recurrent DKA 9 .…”

“…6 Similarly, in adults with type 1 diabetes who were frequently admitted to hospital (frequent flyers), a clinical programme providing case management, mental health support and technology as required, was associated with improvements in glycaemia and reduced rehospitalisation. 7,8 In South Western Sydney, a recent audit demonstrated lower rates of appointment attendance and poorer glucose control among those with recurrent DKA. 9 The profile of these patients justified a review of clinical care and investment in initiatives such as the use of CSII.…”