Psychosocial Factors in Patients Presenting with Diabetic Ketoacidosis

Presentation Number: MON 632
Date of Presentation: April 3rd, 2017

Azni Abdul Wahab*, Sylvia Xu and Peter Shane Hamblin
Western Health, Melbourne, Australia



Diabetic ketoacidosis (DKA) is the most common acute complication of type 1 diabetes (T1D) and it is life threatening. Understanding the factors contributing to the development of DKA is critical in order to develop strategies and allocate resources to manage this high-risk adult population.


A prospective study of 132 consecutive DKA episodes (n=98 patients) admitted to Western Health, Melbourne, Australia was conducted over the 18-month period from April 2015 to September 2016. Prior to hospital discharge when metabolically stable, patients were invited to complete a validated screening tool for indicators of depression, the Patient Health Questionnaire-9 (PHQ-9)1 which assesses the possibility of depression on a scale of none/minimal through to severe. Additionally, the Problem Areas in Diabetes (PAID) questionnaire (score ≥40 is indicative of severe emotional distress)2 was used. Demographic and biochemical data were also collected.


63% patients (n=62) completed both the PHQ-9 and PAID questionnaires. Half were male with a median age of 36 years [25th centile,75thcentile: 21,51]. This cohort had poorly controlled diabetes, with a median HbA1c of 11% (98 mmol/mol). During the study period, a single episode of DKA occurred in 80 patients, with 18 others having recurrent DKA admissions. Insulin discontinuation was the most common precipitating factor in DKA (42%), followed by medical illness/ infection (29%). The prevalence of indicators suggesting at least some depression was 73%, with 38% having indicators of moderate to severe depression. Females had higher indicators of moderate to severe depression compared to males (50% vs. 27%; p=0.14). Using the PAID scale, 37% reported severe emotional diabetes distress with no significant difference in gender. Prevalence of unemployment and illicit substance use was significantly higher in patients with recurrent DKA admissions than those with a single episode (78% vs 50%; p=0.038 and 50% vs 20%; p=0.015 respectively). The median pH was: 7.11 [25th centile,75th centile: 6.99,7.22]. There was no significant association between the severity of acidosis and the depression indicator scores in this cohort. Conclusion

Indicators of possible depression are common in patients with DKA. A significant proportion experienced diabetes distress. Unemployment and illicit drug use were also prevalent. These factors are likely to contribute to poor diabetes self-management. The standard of care for patients with DKA should include the routine availability of psychologists, social workers and addiction medicine specialists.



Nothing to Disclose: AA, SX, PSH