Risk Factors for Recurrent Diabetic Ketoacidosis in Adults With Type 1 Diabetes

Identification of risk factors for recurrent diabetic ketoacidosis (DKA) in patients with type 1 diabetes could help target those at high risk so as to implement preventive measures. The main objective of this study was to identify factors associated with recurrent DKA in adult Canadian patients with type 1 diabetes.

This is a retrospective cohort study of adult patients who had a diagnosis of type 1 diabetes for at least 1 year and who were hospitalized for an isolated or recurrent DKA episode between January 2007 and January 2017 in 5 Québec City tertiary care hospitals. Factors associated with recurrent DKA in bivariate logistic regression with a p value <0.1 were included in a multivariate analysis. Results are reported as odds ratios (OR) and 95% confidence intervals (CI).

We included 212 patients who met the inclusion criteria. Of these, 141 and 71 had an isolated episode or recurrent DKA episodes, respectively. Problems of alcohol or illicit drug abuse (OR 2.81; 95% CI 1.55 to 5.07; p<0.01) and higher glycated hemoglobin levels (OR 1.26; 95% CI 1.08 to 1.47; p<0.01) were associated with recurrent DKA in bivariate analysis. However, only nonadherence to insulin therapy (OR 26.29; 95% CI 1.78 to 388.5; p=0.02) was significantly associated with recurrent DKA in the multivariate analysis, although a diagnosis of psychiatric illness was possibly another risk factor (OR 2.72; 95% CI 0.94 to 7.89; p=0.06).

Interventions targeting adherence to insulin therapy, and possibly also psychiatric illness, could help reduce recurrent DKA in patients with type 1 diabetes.