Mental health issues may contribute to recurrent DKA risk
medwireNews: Researchers find that people with recurrent diabetic ketoacidosis (DKA) have an increased rate of mental health problems such as diabetes distress and personality disorder.
“Our findings could contribute to an understanding of the poor prognosis of people with recurrent DKA, beyond the risk to health posed by each episode,” say Christopher Garrett (Barts Health NHS Trust, London, UK) and co-workers.
They add that this is particularly true for DKA associated with a personality disorder diagnosis, which is itself linked to physical morbidity and a markedly reduced life expectancy.
The study included 23 people with type 1 diabetes and a history of recurrent DKA, defined as two or more episodes within a 12-month period over the preceding 3 years, who were matched for age, sex, and area of residence to 23 people with type 1 diabetes but without recurrent DKA.
The participants with DKA had significantly higher scores on the Beck Anxiety Inventory (median 18.5 vs 5.0) and scored higher for emotional dysregulation on the Difficulties in Emotional Regulation Scale (mean 99.7 vs 72.1).
They also had significantly higher levels of diabetes distress on the Problem Areas in Diabetes Scale (median 48.8 vs 17.5) and scored significantly higher on the Standardised Assessment of Personality score. Using a cutoff of 4 on this latter measure, 69.6% of people with DKA had a personality disorder, compared with 26.1% of the controls.
By contrast, there were no significant differences between the groups in depressive symptoms, attachment style, eating disorders, or interpersonal problems.
The study participants were aged 31 years, on average, and most were of White ethnicity. Those with DKA were significantly less likely to be in current employment than the controls (52.2 vs 91.3%), had significantly higher average glycated hemoglobin (11.4 vs 8.7%; 101 vs 72 mmol/mol), and tested their blood glucose far less frequently, at a median of 20.0 versus 100.5 times over the preceding 28 days.
“Our findings suggest that mental health is potentially a factor in presentation with DKA in some people,” write the researchers in Diabetic Medicine.
They observe that current management of DKA focuses on rapid treatment, a brief educational intervention, and early discharge, but warn: “Without greater understanding of the psychology associated with a particular admission and diabetes self‐management, opportunities to prevent recurrence are potentially missed.”
The team concludes: “Liaison [with] mental health assessment to clarify the presence of a psychiatric diagnosis and subsequent mental health follow‐up could reduce risk of DKA recurrence.”
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