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Diabetic ketoacidosis and subsequent suicide attempt

Type 1 diabetes – September 2020 digest

People with type 1 diabetes who are hospitalised for diabetic ketoacidosis are at increased risk of attempting suicide in subsequent years.

This nationwide registry study from France examined the effects of hospitalisation for diabetic ketoacidosis (DKA) on subsequent suicidal attempts in young adults (age 18–35 years) with type 1 diabetes.

Data on 16 431 young adults who were admitted to hospital with type 1 diabetes in 2008 were analysed. Of this cohort, 1539 (9.4%) were hospitalised for DKA between 2008 and 2010. Compared with those who did not have an episode of DKA over this period, the DKA group was significantly more likely to subsequently attempt suicide over the 9-year follow-up (7.2% vs 2.5%; P<0.001).

After adjustment for age, sex and psychiatric history, people with at least one episode of DKA were more than twice as likely to attempt suicide (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.73–2.83). Psychiatric history was strongly associated with this event (HR, 5.27; 95% CI, 4.23–6.53); indeed, 16.2% of those with a psychiatric history who had an episode of DKA were subsequently hospitalised for attempted suicide. Overall, the risk of suicide attempt was highest in the first year after DKA (HR, 4.68), fell at 3 years (HR, 3.19) and was no longer significant after 5 years.

The authors propose that depressive symptoms leading to both poor glycaemic control (and thus DKA) and suicidal attempts may explain the association between DKA and suicide risk; however, it is also possible that the distress associated with DKA and hospitalisation may have aggravated depression and increased the risk of subsequent suicide attempts. Whatever the direction of causation, these results suggest that all people with type 1 diabetes who are hospitalised for DKA should be screened for depression and suicidal ideation, and that this should happen as early as possible, given that the risk is highest in the first year after DKA.

Petit JM, Goueslard K, Chauvet-Gelinier JC et al (2020) Association between hospital admission for ketoacidosis and subsequent suicide attempt in young adults with type 1 diabetes. Diabetologia 63: 1745–52. https://doi.org/10.1007/s00125-020-05206-4

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