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Recurrent diabetic ketoacidosis and a brief history of brittle diabetes research: contemporary and past evidence in diabetic ketoacidosis research including mortality, mental health and prevention

Garrett, CJ; Choudhary, P; Amiel, SA; Fonagy, P; Ismail, K; (2019) Recurrent diabetic ketoacidosis and a brief history of brittle diabetes research: contemporary and past evidence in diabetic ketoacidosis research including mortality, mental health and prevention. Diabetic Medicine , 36 (11) pp. 1329-1335. 10.1111/dme.14109. Green open access

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Abstract

Pharmacological, technological and educational approaches have advanced treatment of Type 1 diabetes in the last four decades and yet diabetic ketoacidosis (DKA) continues to be a leading cause of admission in Type 1 diabetes. This article begins by reviewing the contemporary epidemiological evidence in DKA. It highlights a rise in DKA episodes in the last two decades; that DKA continues to be the leading cause of death in young people with Type 1 diabetes and that DKA episodes are a marker for subsequent all-cause mortality. It also summarises the limited evidence base for DKA prevention and associations with psychopathology. To emphasise the importance of this group with high-risk Type 1 diabetes and the degree to which they have been overlooked in the past two decades, the article summarises the research literature of recurrent DKA between 1976-1991 when it was extensively investigated as part of the phenomenon of ‘brittle diabetes’. This period saw numerous basic science studies investigating the pathophysiology of recurrent DKA. Subsequently, research centres published their experiences of ‘brittle diabetes’ research participants manipulating their treatment under research conditions. Unfortunately the driver for this behaviour and whether it was indicative of other people with DKA was not pursued. In summary we suggest there has been a stasis in the approach to recurrent DKA prevention, which is likely linked to historical cases of mass sabotage of ‘brittle diabetes’ research. Further investigation is required to clarify possible psychological characteristics that increase risk of DKA and thereby targets for DKA prevention.

Type: Article
Title: Recurrent diabetic ketoacidosis and a brief history of brittle diabetes research: contemporary and past evidence in diabetic ketoacidosis research including mortality, mental health and prevention
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/dme.14109
Publisher version: https://doi.org/10.1111/dme.14109
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/10077587
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