Original article
An approach to prevention of recurrent diabetic ketoacidosis in the pediatric population*

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In 1982 we introduced a program designed to prevent recurrent diabetic ketoacidosis (RDKA), based on the assumption that diabetes education in conjunction with appropriate use of and adherence to insulin therapy should eliminate all RDKA. A hierarchical set of medical, educational, and psychosocial interventions was used. The rate of RDKA was lower after initiation of the program even though patients seen during this period came from lower socioeconomic and more one-parent families (each independently associated with RDKA) than patients seen prior to intervention. In 44 patients with a history of RDKA, insulin omission was documented in 31, inadequate education in 13. Overall, the rate of RDKA decreased from a prereferral mean of 25.2 episodes to a postreferral mean of 2.6 episodes per 100 patient-months (P<0.0001). Metabolic control improved after intervention as documented by a decrease in mean hemoglobin A1 from 14.1% to 10.7% (P<0.0001). RDKA ceased whether or not psychotherapy was used. Although RDKA is causally related to a variety of social, economic, and family dysfunctions, its prevention requires recognition that its proximate cause is omission of insulin and assurance that a support system exists to ensure adherence.

References (32)

  • RosenbloomAL

    Primary and subspecialty care of diabetes mellitus in children and youth

    Pediatr Clin North Am

    (1984)
  • ChandlerM

    Social cognition and life span approaches to the study of child development

    Adv Child Dev Behav

    (1976)
  • MinuchinS et al.

    A conceptual model of psychosomatic illness in children

    Arch Gen Psychiatry

    (1975)
  • OrrDP et al.

    Characteristics of adolescents with poorly controlled diabetes referred to a tertiary care center

    Diabetes Care

    (1983)
  • WhiteK et al.

    Unstable diabetes and unstable families: A psychosocial evaluation of diabetic children with recurrent ketoacidosis

    Pediatrics

    (1984)
  • GlasgowAW et al.

    Socioeconomic and demographic factors and readmissions due to diabetes at a children's hospital

    Diabetes

    (1984)
  • AbrahamEC et al.

    Determination of the glycosylated homoglobins (HbA1) with a new microcolumn procedure: Suitability of the technique for assessing the clinical management of diabets mellitus

    Diabetes

    (1978)
  • RutsteinDD et al.

    Measuring the quality of medical care: A clinical method

    N Engl J Med

    (1976)
  • DelbridgeL

    Educational and psychological factors in the management of diabetes in childhood

    Med J Aust

    (1975)
  • KoskiML

    The coping processes in childhood diabetes

    Acta Paediatr Scand

    (1969)
  • KoskiM et al.

    Adolescent development and behavior: A psychosomatic follow up study of childhood diabetes

  • HamburgBA et al.

    Relationships between behavioral factors and diabetic control in children and adolescents: A camp study

    Psychosom Med

    (1982)
  • SwiftCR et al.

    Adjustment problems in juvenile diabetes

    Psychosom Med

    (1967)
  • BruchH

    Physiological and psychological relationships in diabetes in children

    Psychosom Med

    (1949)
  • KatzP

    Behavior problems in juvenile diabetes

    Can Med Assoc J

    (1957)
  • KhuranaR et al.

    Attitudes of the diabetic child and his parents toward his illness

    Postgrad Med

    (1970)
  • Cited by (0)

    *

    Supported in part by Indiana University Diabetes Research and Training Center and by Grant P60AM20542-07 from the U.S. Public Health Service.

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