{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:40:28Z","timestamp":1789605628016,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T00:00:00Z","timestamp":1610064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000329","name":"Novo Nordisk UK Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000329","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NF\u2010SI\u20100514\u201010157"],"award-info":[{"award-number":["NF\u2010SI\u20100514\u201010157"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite its poor prognosis, the psychological factors associated with recurrent diabetic ketoacidosis are poorly understood. In people with type 1 diabetes, we assessed for psychopathology in those with and without recurrent diabetic ketoacidosis (DKA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The design was a case\u2013control study. Cases were defined as people with two or more DKA episodes in a 12\u2010month period (recurrent DKA). Cases and controls were matched for gender and age. We compared groups for scores on Beck's Anxiety Inventory (BAI), Beck's Depression Inventory II, Difficulty in Emotion Regulation Scale (DERS), Experiences in Close Relationships\u2010Revised, Standardised Assessment of Personality\u2010Abbreviated Scale (SAPAS), Interpersonal Problem Inventory, Eating Disorder Examination Questionnaire and Problem Areas in Diabetes (PAID) using unpaired t\u2010tests or Mann\u2013Whitney <jats:italic>U<\/jats:italic> tests for parametric and non\u2010parametric data, respectively. Correction was made for multiple testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 23 cases and 23 controls were recruited with mean age 31.0 (11.4)\u00a0years and 65.2% were men. Cases had higher HbA<jats:sub>1c<\/jats:sub> levels than controls (101.1 (23.2) vs. 85.7 (21.7) mmol\/mol, (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.02)). Compared to controls, people with recurrent DKA had higher scores on the BAI (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.004), PAID (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.004), DERS (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001) and SAPAS (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Sixteen of 23 (69.6%) cases screened positive for a personality disorder compared to 6 of 23 (26.1%) controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>People with recurrent DKA have elevated levels of anxiety and diabetes distress, greater difficulty with emotion regulation and personality dysfunction compared to matched controls.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14505","type":"journal-article","created":{"date-parts":[[2020,12,25]],"date-time":"2020-12-25T09:47:46Z","timestamp":1608889666000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The psychopathology of recurrent diabetic ketoacidosis: A case\u2013control study"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4425-6609","authenticated-orcid":false,"given":"Christopher J.","family":"Garrett","sequence":"first","affiliation":[{"name":"Diabetes and Metabolism Department Barts Health NHS Trust London UK"},{"name":"Diabetes, Psychiatry and Psychology Research Group Institute of Psychiatry, Psychology and Neuroscience King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0880-4495","authenticated-orcid":false,"given":"Calum D.","family":"Moulton","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7635-4735","authenticated-orcid":false,"given":"Pratik","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Division of Diabetes and Nutritional Sciences King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2686-5531","authenticated-orcid":false,"given":"Stephanie A.","family":"Amiel","sequence":"additional","affiliation":[{"name":"Division of Diabetes and Nutritional Sciences King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0229-0091","authenticated-orcid":false,"given":"Peter","family":"Fonagy","sequence":"additional","affiliation":[{"name":"Division of Psychology and Language Sciences University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6084-449X","authenticated-orcid":false,"given":"Khalida","family":"Ismail","sequence":"additional","affiliation":[{"name":"Diabetes, Psychiatry and Psychology Research Group Institute of Psychiatry, Psychology and Neuroscience King's College London London 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