Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes

Health Psychol. 2019 Jul;38(7):577-585. doi: 10.1037/hea0000719. Epub 2019 Apr 11.


Objective: Diabetic ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with Type 1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts.

Method: Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict the number of DKA hospitalizations and HbA1c approximately 1 year after assessment, accounting for sociodemographics. A total of 174 youth 12-18 years old with T1D (M = 14.68, SD = 1.77) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c at 1-year follow-up.

Results: Thirty-one participants had at least 1 episode of DKA based on chart review. Greater duration of diabetes, higher baseline HbA1c, lower income, identifying as non-Hispanic White, and higher youth report of internalizing symptoms were significant predictors of DKA at follow-up (p < .05). Identifying as Black-African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up (p < .05).

Conclusions: Future studies should assess the utility and accuracy of using screeners for internalizing symptoms in pediatric endocrinology clinics to identify youth at risk for DKA hospitalizations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

MeSH terms

  • Adolescent
  • Child
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / diagnosis*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetic Ketoacidosis / blood*
  • Diabetic Ketoacidosis / diagnosis*
  • Diabetic Ketoacidosis / epidemiology
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / metabolism*
  • Hospitalization / trends*
  • Humans
  • Male
  • Predictive Value of Tests
  • Risk Factors
  • Surveys and Questionnaires


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

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