P-284: Drivers of recurrent DKA in youth with type 1 diabetes: beyond biomedical factors
P Wamalwa, C Ngaruiya, C MugoAbstract
Introduction
Recurrent diabetic ketoacidosis (DKA) remains a major contributor to morbidity and mortality among youth with Type 1 Diabetes (T1D). However, the interaction between self-care practices, social determinants of health (SDOH), psychological factors, and glycemic outcomes is not well understood.
Objectives
To assess the burden, self-care correlates, and multilevel predictors of recurrent DKA among youth and young adults with T1D in Kenya.
Methods
An analytical cross-sectional study among 164 individuals aged 18–34 years attending four diabetes clinics. DKA episodes were categorized as none, single, 2–3, and ≥4. We assessed SDOH, psychological outcomes (PAID, PHQ-9, GAD-7), and self-care practices including glucose monitoring, insulin adherence, and access to supplies. Multivariable logistic regression identified predictors of recurrent (≥2) and severe (≥4) DKA.
Results
DKA burden was high: 12.8% reported no prior DKA, 28.7% one episode, 35.4% 2–3 episodes, and 23.2% ≥4 episodes. Suboptimal self-care was common, including infrequent glucose monitoring (<3 times/day in 61.6%), limited access to test strips (27.4%), and insulin interruption (26.2%). Poor self-care was associated with higher HbA1c, which independently predicted recurrent (aOR 1.34) and severe DKA (aOR 1.48). Recurrent DKA was linked to diabetes distress (aOR 2.21), housing instability (p=0.024), lack of peer support (p=0.040), and lower diabetes literacy (p=0.003). Severe DKA was associated with food insecurity (aOR 2.41) and diabetes distress (aOR 2.67), while support program participation was protective (aOR 0.32).
Conclusions
Recurrent DKA reflects a convergence of impaired self-care, social vulnerability, and psychological distress. While poor self-care contributes to worse glycemic control, severe DKA is strongly influenced by structural factors such as food insecurity. Diabetes support programs improve self-care and reduce severe DKA, supporting integrated, patient-centered care models.