Abstract
Longitudinal studies indicate that 20% of paediatric patients account for 80% of all admissions for diabetic ketoacidosis (DKA). The frequency of DKA peaks during adolescence and, although individuals generally go into remission, they may continue to have bouts of recurrent DKA in adulthood. The evidence for insulin omission being the behavioural precursor to recurrent DKA is reviewed and discussed. Thereafter the range of possible psychosocial causes is explored and the evidence for each discussed. Approaches to assessing the individual and their family to identify aetiology and therefore appropriate intervention are considered and treatment options reviewed. Finally, the paper examines potential risk factors for recurrent DKA, possible strategies for identifying these early and how to use these assessments to prevent subsequent recurrent DKA.
References
1.
Laing SP, Swerdlow AJ, Slater SD, Botha JL, Burden AC, Waugh NR, Smith AWM, Hill RD, Bingley PJ, Patterson CC, Qiao Z, Keen H: The British Diabetic Association Cohort Study, II: Cause specific mortality in patients with insulin-treated diabetes mellitus. Diab Med 1999;16:471.
2.
Kovacs M, Charron-Prochownik D, Obrosky DS: A longitudinal study of biomedical and psychosocial predictors of multiple hospitalizations among young people with insulin-dependent diabetes mellitus. Diab Med 1995;12:142–148.
3.
Herskowitz RD, Jacobson AM, Cole C, Hauser ST, Wolfsdorf JI, Willett JB, Milley JE, Wertileb D: Psychosocial predictors of acute complications of diabetes in youth. Diab Med 1995;12:612–618.
4.
White K, Kolman ML, Wexler P, Polin G, Winter RJ: Unstable diabetes and unstable families: A psychosocial evaluation of diabetic children with recurrent ketoacidosis. Pediatrics 1984;73:749–755.
5.
Rosen H, Lidz T: Emotional factors in the precipitation of recurrent diabetic ketoacidosis. Psychosom Med 1949;11:211–215.
6.
Liss DS, Waller DA, Kennard BD, McIntire D, Capra P, Stephens J: Psychiatric illness and family support in children and adolescents with diabetic ketoacidosis: A controlled study. J Am Acad Child Adol Psych 1998:37:536–544.
7.
Tattersall RB: Brittle diabetes revisited: The Third Arnold Bloom Memorial Lecture. Diab Med 1997;14:99–110.
8.
Morris AD, Boyle DIR, McMahon AD, Greene SA, MacDonald TM, Newton RW: Adherence to insulin treatment, glycemic control and ketoacidosis in insulin-dependent diabetes mellitus. Lancet 1997;350:1505–1510.
9.
Tattersall RB, Gregory R, Selby C, Kerr D, Heller S: Course of brittle diabetes: 12 year follow up. BMJ 1991;302:1240–1243.
10.
Kent LA, Gill GV, Williams G: Mortality and outcome of patients with brittle diabetes and recurrent ketoacidosis. Lancet 1994;344:778–781.
11.
Jones JM, Lawson ML, Daneman D, Olmsted M, Rodin G: Eating disorders in adolescent females with and without type 1 diabetes: Cross sectional study. BM J 2000;320:1563–1566.
12.
Talbot F, Nouwen A: A review of the relationship between depression and diabetes in adults: Is there a link ? Diab Care (submitted: 2000).
13.
Gavard JA, Lustman PL, Clouse RE: Prevalence of depression in adults with diabetes: An epidemiological evaluation. Diab Care 1993;16:1167–1178.
14.
Weissberg-Benchel J, Wirtz P, Glasgow AM, Turek J, Tynan WD, Ward J: Adolescent diabetes management and mismanagement. Diab Care 1995;18:77–82.
15.
Hampson SE, Skinner TC, Hart J, Storey L, Gage H, Foxcroft D, Kimber A, Shaw K: Effects of educational and psychosocial interventions for adolescents with diabetes: A systematic review. Health Tech Assess 2001;5:1–70.
16.
Golden MP, Herrold AJ, Orr DP: An approach to prevention of recurrent diabetic ketoacidosis in the pediatric population. J Pediatrics 1985;107:195–200.
17.
Chase HP, Rose B, Hoops S, Archer PG, Cribari JM: Techniques for improving glucose control in type I diabetes. Pediatrician 1985;12:229–235.
© 2002 S. Karger AG, Basel
2002
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