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Author Notes:

Corresponding author: Guillermo Umpierrez, geumpie@emory.edu.

L.R. contributed to acquiring and interpreting data and writing the manuscript.

J.B., M.H., D.U., and N.P. contributed to acquiring and interpreting data.

D.S. contributed to the study design, checking the accuracy of the data, interpreting the data, and revising the article.

L.P. conducted the statistical analysis and contributed to interpreting the data.

G.U. contributed to the study design, interpreting the data, and writing the manuscript.

No other potential conflicts of interest relevant to this article were reported.


Research Funding:

This investigator-initiated study was supported by a research grant from Baxter Pharmaceuticals (G.U.), National Institutes of Health Grant UL1-RR-025008 (Atlanta Clinical and Translational Science Institute), and American Diabetes Association Grant 7-03-CR-35 (G.U.).

G.U. is supported by a clinical research grant from the American Diabetes Association (7-07-CR-56) and National Institutes of Health Grant UL1-RR-025008 (Atlanta Clinical and Translational Science Institute).

D.S. receives research support from the National Institutes of Health (K08-DK-0830361).

Recurrent Diabetic Ketoacidosis in Inner-City Minority Patients Behavioral, socioeconomic, and psychosocial factors


Journal Title:

Diabetes Care


Volume 34, Number 9


, Pages 1891-1896

Type of Work:

Article | Final Publisher PDF


OBJECTIVE To conduct a bedside study to determine the factors driving insulin noncompliance in inner-city patients with recurrent diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS We analyzed socioeconomic and psychological factors in 164 adult patients with DKA who were admitted to Grady Hospital between July 2007 and August 2010, including demographics, diabetes treatment, education, and mental illness. The Patient Health Questionnaire-9 and the Short Form-36 surveys were used to screen for depression and assess quality of life. RESULTS The average number of admissions was 4.5 ± 7 per patient. A total of 73 patients presented with first-time DKA, and 91 presented with recurrent DKA; 96% of patients were African American. Insulin discontinuation was the leading precipitating cause in 68% of patients; other causes were new-onset diabetes (10%), infection (15%), medical illness (4%), and undetermined causes (3%). Among those who stopped insulin, 32% gave no reasons for stopping, 27% reported lack of money to buy insulin, 19% felt sick, 15% were away from their supply, and 5% were stretching insulin. Compared with first-time DKA, those with recurrent episodes had longer duration of diabetes (P < 0.001), were a younger age at the onset of diabetes (P = 0.04), and had higher rates of depression (P = 0.04), alcohol (P = 0.047) and drug (P < 0.001) abuse, and homelessness (P = 0.005). There were no differences in quality-of-life scores, major psychiatric illnesses, or employment between groups. CONCLUSIONS Poor adherence to insulin therapy is the leading cause of recurrent DKA in inner-city patients. Several behavioral, socioeconomic, psychosocial, and educational factors contribute to poor compliance. The recognition of such factors and the institution of culturally appropriate interventions and education programs might reduce DKA recurrence in minority populations.

Copyright information:

© 2011 by the American Diabetes Association.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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