title: Recurrent diabetic ketoacidosis in two community teaching hospitals.
abstract: OBJECTIVE
  To identify the factors that influence recurrent (one or more previous episodes) diabetic ketoacidosis (DKA), which we refer to as recurrent DKA, in two private community teaching hospitals.
  
  
  METHODS
  Retrospective chart review of the demographics, diabetes treatment regimens, diabetes education, medical comorbidities, medical insurance status, and mental illness/psychosocial factors of 80 patients with recurrent DKA who were admitted to the resident teaching services at two Birmingham, Alabama community teaching hospitals, Trinity Medical Center (TMC) and Princeton Baptist Medical Center (PBMC), between May 2006 and May 2012.
  
  
  RESULTS
  The average number of admissions for recurrent DKA was 2.5 per patient. Eighty-four percent of the episodes of recurrent DKA were due to omission of insulin; 44% of patients reported omission of insulin because of illness and 40% stopped insulin for unknown reasons. Medical illnesses, including infection, accounted for only 31% of recurrent DKA admissions.
  
  
  CONCLUSIONS
  Omission of insulin is the major cause of recurrent DKA. Psychosocial and socioeconomic factors contribute to poor adherence to therapy. Identifying these factors and instituting appropriate interventions may reduce the incidence of recurrent DKA.
authors.affiliation: Department of Internal Medicine, Baptist Health System, Birmingham, Alabama.
authors.forename: Sheela
authors.initials: S
authors.lastname: Lohiya
authors.forename: Robert
authors.initials: R
authors.lastname: Kreisberg
authors.forename: Vipin
authors.initials: V
authors.lastname: Lohiya
mesh_terms: D000328:Adult; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies