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Recurrent diabetic ketoacidosis especially problematic among urban minority patients
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Multiple factors, including psychological issues and socioeconomic status, adversely affect adherence to diabetes treatment, leading to high rates of diabetic ketoacidosis among inner-city minority patients with the disease, according to recent study results.
Previous research identified poor compliance with diabetes therapies as a major cause of diabetic ketoacidosis in urban minority patients. Researchers at Grady Memorial Hospital in Atlanta analyzed information from 164 patients with diabetes who were admitted to the medical center for diabetic ketoacidosis (96% black) to investigate why adherence remains low in this population. They examined quality of life and depression using the Patient Health Questionnaire-9 and the Short Form-36 surveys.
Precipitating factors of diabetic ketoacidosis
On average, the number of hospital admissions was 4.5 per patient. At the start of the study, 91 patients had recurrent diabetic ketoacidosis, whereas 73 patients were experiencing their first hospital admission related to the condition. Results highlighted insulin discontinuation as the most common cause of diabetic ketoacidosis in 68% of the cohort. Other primary precipitating factors included new-onset diabetes (10%), infection (15%), medical illness (4%) and undetermined causes (3%).
Reasons for insulin discontinuation varied. Thirty-two percent provided no reason; 27% lacked money to purchase the treatment; 19% felt too ill; 15% reported that their insulin was lost, stolen or that they were away from it; and 5% were using lower doses to extend their supply, the researchers said.
Findings also indicated the following:
- 62% of patients were uninsured.
- 13% had Medicare.
- 31% had Medicaid.
- 17% lacked stable employment.
- 16% were homeless.
- 4.9% had been incarcerated.
- 46% had a history of depression.
- 36% had a history of taking antidepressants.
- 3% were diagnosed with schizophrenia or bipolar disorder.
- 6.1% had taken antipsychotic medications.
The researchers also said the average Patient Health Questionnaire-9 score was 9.8, suggesting mild to moderate depression. In addition, patients with recurrent diabetic ketoacidosis were younger at the onset of diabetes, had higher rates of alcohol and drug abuse, and were more likely to be homeless compared with those experiencing diabetic ketoacidosis for the first time.
Novel approaches for prevention
Poor adherence to insulin treatment is related to many socioeconomic and psychosocial factors, the researchers said.
“Novel approaches to patient education incorporating a variety of health care beliefs and socioeconomic issues are critical to an effective prevention program,” they wrote. “Because [diabetic ketoacidosis] represents an important financial burden and health care problem in inner-city populations, it would be wise to invest resources in expanding health care coverage and medication cost as well in developing strategies to increase treatment compliance and prevent [diabetic ketoacidosis] admissions.”
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Disclosure: The researchers report no relevant financial disclosures.
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