Recurrent diabetic ketoacidosis

ABSTRACT Objective The purpose of this study is to examine risk factors for recurrence of diabetic ketoacidosis and determine interventions to prevent future admissions. Materials and methods Review article. Results Recurrent diabetic ketoacidosis is a serious and not uncommon health problem. Diabetic ketoacidosis is associated with severe morbidity and mortality and hospital admissions due to this problem constitute a serious economic burden on the healthcare system. Younger age at diabetic ketoacidosis onset, poor baseline glycemic control and elevated HbA1C, patient comorbidities, depression, alcohol or substance abuse, particularly active cocaine use, have been associated with recurrent diabetic ketoacidosis. In addition, socioeconomic factors (such as ethnic minority status, use of public health insurance and underinsurance), psychosocial, economic, and behavioral factors (including financial constraint, stretching a limited insulin supply, and homelessness) have been all reported to be associated with readmission among diabetic ketoacidosis patients. Conclusions Identifying high-risk patients during the first diabetic ketoacidosis admission and performing relevant interventions (repeated instructions of insulin use, social help and involvement of family members in medical treatment, collaboration with the patient’s primary care physician in order to establish a close and frequent follow up program) may help prevent future admissions. Further studies need to take place to determine whether early interventions with those factors prevent future admissions.

摘要
研究目的：本研究旨在探讨糖尿病酮症酸中毒（diabetic ketoacidosis）复发的危险因素，并确定可预防患者后续住院的干预措施。
材料与方法：本研究为综述类文章。
结果：复发性糖尿病酮症酸中毒是一种严重且并非罕见的健康问题。糖尿病酮症酸中毒可引发严重的发病率与死亡率，因该病导致的住院治疗也给医疗保健系统带来了沉重的经济负担。糖尿病酮症酸中毒起病时年龄较小、基线血糖控制不佳且糖化血红蛋白（HbA1C）水平升高、患者合并其他疾病、抑郁、酒精或药物滥用（尤其是当前仍在吸食可卡因）均与复发性糖尿病酮症酸中毒相关。此外，社会经济因素（如少数民族身份、使用公共医疗保险以及保险保障不足）、社会心理、经济与行为因素（包括经济拮据、因胰岛素供应有限而缩减用量、无家可归）均被报道与糖尿病酮症酸中毒患者的再住院相关。
结论：在患者首次因糖尿病酮症酸中毒住院期间识别高危人群，并实施针对性干预措施（如反复讲解胰岛素使用方法、提供社会支持并动员家属参与诊疗、与患者的初级保健医师协作以建立紧密且高频的随访方案），或可帮助预防后续住院。未来仍需开展进一步研究，以明确针对上述危险因素的早期干预是否可有效避免患者再次住院。