{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:25:19Z","timestamp":1761110719088,"version":"build-2065373602"},"reference-count":81,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T00:00:00Z","timestamp":1749340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FIS (Fondo de Investigaciones Sanitarias\u2014Health Research Fund, Instituto de Salud Carlos III)","award":["PI20\/00118","970970"],"award-info":[{"award-number":["PI20\/00118","970970"]}]},{"name":"Madrid Government (Comunidad de Madrid\u2013Spain)","award":["PI20\/00118","970970"],"award-info":[{"award-number":["PI20\/00118","970970"]}]},{"name":"Universidad Complutense de Madrid, Grupo de Investigaci\u00f3n en Epidemiolog\u00eda de las Enfermedades Cr\u00f3nicas de Alta Prevalencia en Espa\u00f1a","award":["PI20\/00118","970970"],"award-info":[{"award-number":["PI20\/00118","970970"]}]},{"name":"Grupo de Investigaci\u00f3n en Biomedicina Predictiva e Investigaci\u00f3n Traslacional en las Enfermedades Respiratorias, Cardiovasculares y Metab\u00f3licas of the Health Research Institute of the Hospital Cl\u00ednico San Carlos (IdISSC)","award":["PI20\/00118","970970"],"award-info":[{"award-number":["PI20\/00118","970970"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: We aim to describe and analyze the clinical characteristics and hospital outcomes of alcohol-related hospital admissions (ARHAs) among adolescents and young adults (12 to 35 years) with type 1 diabetes (T1D) in Spain from 2016 to 2023. We also aim to determine factors associated with admission to the intensive care unit (ICU). Methods: A descriptive observational study was carried out based on the Spanish Hospital Discharge Database (SHDD). ICD-10 codes were used to identify ARHAs in T1D patients. Joinpoint regression was used to analyze the time trend, and multivariable logistic regression was conducted to identify predictors of ICU admission. Results: We recorded 39,091 discharges with T1D (52.59% females); of these, 1274 (3.26% prevalence) were identified as ARHAs (74.10% males vs. 25.90% females). Joinpoint regression showed a significant increase among females and stable prevalence in males. Females with T1D and ARHAs were younger than males, and more frequently had diabetic ketoacidosis (DKA), mental disorders, and external causes of morbidity and mortality, whereas greater drug use was detected among males. Overall, 20.80% of ARHAs required ICU admission. Predictors of ICU admission included DKA, drug use, hypoglycemia, and female sex (OR: 1.39; 95% CI: 1.02\u20131.90). Conclusions: The frequency of ARHAs in young people with T1D in Spain rose between 2016 and 2023, mainly owing to the increase in the percentage of females requiring ARHA. DKA and drug and tobacco consumption were very common in ARHAs. Admission to the ICU is frequent, increases over time, and is associated with female sex, DKA, hypoglycemia, and drug use.<\/jats:p>","DOI":"10.3390\/jcm14124053","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T05:54:05Z","timestamp":1749448445000},"page":"4053","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Alcohol-Related Hospitalizations Among Adolescents and Young Adults with Type 1 Diabetes in Spain, 2016\u22122023"],"prefix":"10.3390","volume":"14","author":[{"given":"Lucia","family":"Jim\u00e9nez-Sierra","sequence":"first","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5551-5181","authenticated-orcid":false,"given":"Ana","family":"L\u00f3pez-de-Andres","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Faculty of Pharmacy, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5790-1959","authenticated-orcid":false,"given":"Valent\u00edn","family":"Hern\u00e1ndez-Barrera","sequence":"additional","affiliation":[{"name":"Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5906-9393","authenticated-orcid":false,"given":"Rodrigo","family":"Jim\u00e9nez-Garcia","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9897-4847","authenticated-orcid":false,"given":"David","family":"Carabantes-Alarcon","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9s","family":"Bodas-Pinedo","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6604-5197","authenticated-orcid":false,"given":"Elena","family":"Labajo-Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 J.","family":"Zamorano-Le\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,8]]},"reference":[{"unstructured":"World Health Organization (2025, May 20). Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders, Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/377960\/9789240096745-eng.pdf?sequence=1.","key":"ref_1"},{"unstructured":"Observatorio Espa\u00f1ol de Las Drogas y Las Adicciones (2023). Informe 2023. Alcohol, Tabaco y Drogas Ilegales en Espa\u00f1a, Ministerio de Sanidad, Delegaci\u00f3n del Gobierno para el Plan Nacional Sobre Drogas. Available online: https:\/\/pnsd.sanidad.gob.es\/en\/profesionales\/sistemasInformacion\/sistemaInformacion\/pdf\/2023_Informe_Indi_urgencias.pdf.","key":"ref_2"},{"unstructured":"Observatorio Espa\u00f1ol de las Drogas y Las Adicciones (2024). Monograf\u00eda Alcohol 2024. Consumo y Consecuencias, Ministerio de Sanidad, Delegaci\u00f3n del Gobierno Para el Plan Nacional Sobre Drogas. Available online: https:\/\/pnsd.sanidad.gob.es\/profesionales\/publicaciones\/catalogo\/catalogoPNSD\/publicaciones\/pdf\/2024_OEDA_MonografiaAlcoholConsumoConsecuencias.pdf.","key":"ref_3"},{"unstructured":"Ministerio de Sanidad (2025, May 20). EDADES 2024 Encuesta Sobre Alcohol y Otras Drogas en Espa\u00f1a (EDADES) 1995\u20132024. Madrid, Spain. Available online: https:\/\/pnsd.sanidad.gob.es\/profesionales\/sistemasInformacion\/sistemaInformacion\/pdf\/2024_Informe_EDADES.pdf.","key":"ref_4"},{"unstructured":"Ministerio de Sanidad (2025, May 20). ESTUDES 2023. Encuesta Sobre Uso de Drogas en Ense\u00f1anzas Secundarias en Espa\u00f1a (ESTUDES), 1994\u20132023. Madrid, Spain. Available online: https:\/\/pnsd.sanidad.gob.es\/en\/profesionales\/sistemasInformacion\/sistemaInformacion\/pdf\/ESTUDES_2023_Informe.pdf.","key":"ref_5"},{"doi-asserted-by":"crossref","unstructured":"van Roozendaal, H., Verhulst, S., Glazemakers, I., De Meulder, F., Vander Auwera, A., Bael, A., Van Damme, E., Vlemincx, I., De Dooy, J., and van der Lely, N. (2023). Characteristics of Adolescents Admitted with Acute Alcohol Intoxication: A Retrospective Multicentre Study in Antwerp, Belgium, in the Period 2015\u20132021. Children, 10.","key":"ref_6","DOI":"10.3390\/children10081378"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1080\/14659891.2019.1664665","article-title":"Visits of adolescents for acute alcohol intoxication to emergency departments in Northern Italy: Natives and non-natives","volume":"25","author":"Pavarin","year":"2020","journal-title":"J. Subst. Use"},{"doi-asserted-by":"crossref","unstructured":"Trefan, L., Gartner, A., Alcock, A., Farewell, D., Morgan, J., Fone, D., and Paranjothy, S. (2019). Epidemiology of alcohol-related emergency hospital admissions in children and adolescents: An e-cohort analysis in Wales in 2006\u20132011. PLoS ONE, 14.","key":"ref_8","DOI":"10.1371\/journal.pone.0217598"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s00592-010-0243-z","article-title":"Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis","volume":"50","author":"Isidro","year":"2013","journal-title":"Acta Diabetol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1542\/peds.2015-0722","article-title":"Alcohol and Marijuana Use and Treatment Nonadherence Among Medically Vulnerable Youth","volume":"136","author":"Weitzman","year":"2015","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S2213-8587(22)00218-2","article-title":"Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: A modelling study","volume":"10","author":"Gregory","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"unstructured":"Ministerio de Sanidad (2025, May 20). Base de Datos Cl\u00ednicos de Atenci\u00f3n Primaria (BDCAP) del Sistema Nacional de Salud. 2020. Madrid. Spain. Available online: https:\/\/www.sanidad.gob.es\/estadEstudios\/estadisticas\/estadisticas\/estMinisterio\/SIAP\/3Prev_diabetes_mellitus.pdf.","key":"ref_12"},{"key":"ref_13","first-page":"642","article-title":"Clinical characteristics and management of type 1 diabetes in Spain. The SED1 study","volume":"68","author":"Conde","year":"2021","journal-title":"Endocrinol. Diabetes Nutr."},{"key":"ref_14","first-page":"189","article-title":"Incidence of type 1 diabetes mellitus in Asturias (Spain) between 2011 and 2020","volume":"70","year":"2023","journal-title":"Endocrinol. Diabetes Nutr. (Engl. Ed.)"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.endinu.2022.10.005","article-title":"Incidence of type 1 diabetes in Navarra, 2009\u20132020. Evidence of a stabilization","volume":"70","year":"2023","journal-title":"Endocrinol. Diabetes Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.anpedi.2020.08.005","article-title":"Evolution of the incidence of type 1 diabetes mellitus in the Community of Madrid, 1997\u20132016","volume":"95","year":"2021","journal-title":"An. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1111\/pedi.13089","article-title":"Demographic and socioeconomic patterns in the risk of alcohol-related hospital admission in children and young adults with childhood onset type-1 diabetes from a record-linked longitudinal population cohort study in Wales","volume":"21","author":"Gartner","year":"2020","journal-title":"Pediatr. Diabetes"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1111\/pedi.12496","article-title":"Self-reported regular alcohol consumption in adolescents and emerging adults with type 1 diabetes: A neglected risk factor for diabetic ketoacidosis? Multicenter analysis of 29 630 patients from the DPV registry","volume":"18","author":"Hermann","year":"2017","journal-title":"Pediatr. Diabetes"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11892-022-01496-7","article-title":"Recent Rates of Substance Use Among Adolescents and Young Adults with Type 1 Diabetes in the USA","volume":"23","author":"Sannegowda","year":"2023","journal-title":"Curr. Diab. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"107980","DOI":"10.1016\/j.diabres.2019.107980","article-title":"Alcohol consumption patterns in young adults with type 1 diabetes: The SEARCH for diabetes in youth study","volume":"159","author":"Roberts","year":"2020","journal-title":"Diabetes. Res. Clin. Pract."},{"doi-asserted-by":"crossref","unstructured":"Sergel-Stringer, O.T., Al-Sallami, H.S., Styles, S.E., Boucsein, A., de Bock, M.I., and Wheeler, B.J. (2023). Knowledge, safety, and impact of alcohol consumption in young adults with type 1 diabetes mellitus: A qualitative study. BMC Endocr. Disord., 23.","key":"ref_21","DOI":"10.1186\/s12902-023-01471-7"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1093\/pch\/pxx157","article-title":"Prevalence of alcohol, tobacco, cannabis and other illicit substance use in a population of Canadian adolescents with type 1 diabetes compared to a general adolescent population","volume":"23","author":"Potter","year":"2018","journal-title":"Paediatr. Child Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/pedi.13266","article-title":"Risk of substance use disorders among adolescents and emerging adults with type 1 diabetes: A population-based cohort study","volume":"22","author":"Creo","year":"2021","journal-title":"Pediatr. Diabetes"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1177\/0009922820902433","article-title":"Substance Use Among Adolescents and Young Adults with Type 1 Diabetes: Discussions in Routine Diabetes Care","volume":"59","author":"Bento","year":"2020","journal-title":"Clin. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S2213-8587(19)30410-3","article-title":"Alcohol and illicit drug use in people with diabetes","volume":"8","author":"Pastor","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1007\/s00394-018-1777-z","article-title":"Improved adherence to Mediterranean Diet in adults with type 1 diabetes mellitus","volume":"58","author":"Alcubierre","year":"2019","journal-title":"Eur. J. Nutr."},{"doi-asserted-by":"crossref","unstructured":"Zucchini, S., Tumini, S., Scaramuzza, A.E., Bonfanti, R., Delvecchio, M., Franceschi, R., Iafusco, D., Lenzi, L., Mozzillo, E., and Passanisi, S. (2024). Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia. Front. Endocrinol., 15.","key":"ref_27","DOI":"10.3389\/fendo.2024.1387537"},{"key":"ref_28","first-page":"784","article-title":"Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: A cross-sectional, multicenter study","volume":"66","author":"Gomes","year":"2022","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/dme.13004","article-title":"Risk factors for recurrent admissions with diabetic ketoacidosis: A case-control observational study","volume":"33","author":"Cooper","year":"2016","journal-title":"Diabet. Med."},{"doi-asserted-by":"crossref","unstructured":"Foti Randazzese, S., La Rocca, M., Bombaci, B., Di Pisa, A., Giliberto, E., Inturri, T., Militi, D., Lombardo, F., Gitto, E., and Salzano, G. (2025). Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care. Children, 12.","key":"ref_30","DOI":"10.3390\/children12010110"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4153278","DOI":"10.1155\/2016\/4153278","article-title":"Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus","volume":"2016","author":"Hogendorf","year":"2016","journal-title":"J. Diabetes Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/pch\/pxy075","article-title":"Knowledge and practice of harm-reduction behaviours for alcohol and other illicit substance use in adolescents with type 1 diabetes","volume":"24","author":"Potter","year":"2019","journal-title":"Paediatr. Child Health"},{"key":"ref_33","first-page":"555","article-title":"Association between alcohol screening scores and diabetic self-care behaviors","volume":"44","author":"Thomas","year":"2012","journal-title":"Fam Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/j.1464-5491.2006.01878.x","article-title":"Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours","volume":"23","author":"Ahmed","year":"2006","journal-title":"Diabet Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"d5364","DOI":"10.1136\/bmj.d5364","article-title":"Time trends in mortality in patients with type 1 diabetes: Nationwide population based cohort study","volume":"343","author":"Harjutsalo","year":"2011","journal-title":"BMJ"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2337\/dc16-1213","article-title":"Long-term Mortality and End-Stage Renal Disease in a Type 1 Diabetes Population Diagnosed at Age 15\u201329 Years in Norway","volume":"40","author":"Gagnum","year":"2017","journal-title":"Diabetes Care"},{"unstructured":"Ministerio de Sanidad, Servicios Sociales e Igualdad (2015). Real Decreto 69\/2015, de 6 de Febrero, por el que se Regula el Registro de Actividad de Atenci\u00f3n Sanitaria Especializada (Spanish National Hospital Discharge Database), BOE. Available online: https:\/\/www.mscbs.gob.es\/estadEstudios\/estadisticas\/docs\/BOE_RD_69_2015_RAE_CMBD.pdf.","key":"ref_37"},{"unstructured":"(2025). Joinpoint Regression Program, Version 5.4.0.0; Statistical Methodology and Applications Branch, Surveillance Research Program.","key":"ref_38"},{"doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, John Wiley & Sons, Inc.. [3rd ed.].","key":"ref_39","DOI":"10.1002\/9781118548387"},{"unstructured":"(2025, March 31). Ministerio de Sanidad, Consumo y Bienestar Social. Solicitud de Extracci\u00f3n de Datos\u2014Extraction Request (Spanish National Hospital Discharge Database). Available online: https:\/\/www.mscbs.gob.es\/estadEstudios\/estadisticas\/estadisticas\/estMinisterio\/SolicitudCMBDdocs\/2018_Formulario_Peticion_Datos_RAE_CMBD.pdf.","key":"ref_40"},{"unstructured":"(2025, March 31). Ley 14\/2007, Available online: https:\/\/www.boe.es\/eli\/es\/l\/2007\/07\/03\/14.","key":"ref_41"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/acer.13559","article-title":"Trends in alcohol-related emergency department visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014","volume":"42","author":"White","year":"2018","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.35946\/arcr.v40.2.01","article-title":"Gender Differences in the Epidemiology of Alcohol Use and Related Harms in the United States","volume":"40","author":"White","year":"2020","journal-title":"Alcohol Res."},{"unstructured":"Yoon, Y.H., and Chen, C.M. (2025, May 20). Surveillance Report #114. Trends in Alcohol Related Morbidity Among Community Hospital Discharges, United States, 2000\u20132017, Available online: https:\/\/pubs.niaaa.nih.gov\/publications\/surveillance114\/Cirr17.htm.","key":"ref_44"},{"unstructured":"Chen, C.M. (2025, May 20). Trends in Alcohol-Related Morbidity Among Short-Stay Community Hospital Discharges, United States, 1979\u20132007. [Bethesda, Md]: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health. 2010, Available online: https:\/\/www.govinfo.gov\/content\/pkg\/GOVPUB-HE20-PURL-gpo710\/pdf\/GOVPUB-HE20-PURL-gpo710.pdf.","key":"ref_45"},{"key":"ref_46","first-page":"189","article-title":"Trends in psychiatric hospitalization for alcohol and drugs in Castilla y Le\u00f3n between 2005 and 2015","volume":"34","author":"Roncero","year":"2022","journal-title":"Adicciones"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1136\/bmj.330.7486.301","article-title":"Adolescent development","volume":"330","author":"Christie","year":"2005","journal-title":"BMJ"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.auec.2022.06.001","article-title":"Hospital presentations with diabetic ketoacidosis: A retrospective review","volume":"26","author":"James","year":"2023","journal-title":"Australas Emerg. Care"},{"key":"ref_49","first-page":"26","article-title":"Hospital Admission for Diabetic Ketoacidosis in Thai Children and Adolescents with Type 1 Diabetes: A National Study During 2015\u20132019","volume":"17","author":"Wankanit","year":"2025","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1210\/clinem\/dgab287","article-title":"National Trends in Pediatric Admissions for Diabetic Ketoacidosis, 2006\u20132016","volume":"106","author":"Everett","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.2337\/dc22-0152","article-title":"Health Care Utilization Trends Across the Transition Period in a National Cohort of Adolescents and Young Adults with Type 1 Diabetes","volume":"45","author":"Garvey","year":"2022","journal-title":"Diabetes Care."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.2337\/dc23-0180","article-title":"National Trends in Hyperglycemia and Diabetic Ketoacidosis in Children, Adolescents, and Young Adults with Type 1 Diabetes: A Challenge Due to Age or Stage of Development, or Is New Thinking About Service Provision Needed?","volume":"46","author":"Holman","year":"2023","journal-title":"Diabetes Care"},{"doi-asserted-by":"crossref","unstructured":"Ebrahimi, F., Kutz, A., Christ, E.R., and Szinnai, G. (2022). Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study. Front. Endocrinol., 13.","key":"ref_53","DOI":"10.3389\/fendo.2022.940990"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s13643-020-01411-9","article-title":"The effects of recreational cannabis use on glycemic outcomes and self-management behaviours in people with type 1 and type 2 diabetes: A rapid review","volume":"9","author":"Porr","year":"2020","journal-title":"Syst. Rev."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1001\/jamainternmed.2018.5142","article-title":"Association Between Cannabis Use and Risk for Diabetic Ketoacidosis in Adults with Type 1 Diabetes","volume":"179","author":"Akturk","year":"2019","journal-title":"JAMA Intern. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4158\/EP.13.1.22","article-title":"Active use of cocaine: An independent risk factor for recurrent diabetic ketoacidosis in a city hospital","volume":"13","author":"Nyenwe","year":"2007","journal-title":"Endocr. Pract."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s00431-017-2895-y","article-title":"Alcohol and cigarette use among adolescents with type 1 diabetes","volume":"176","author":"Hogendorf","year":"2017","journal-title":"Eur. J. Pediatr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1177\/1932296820922254","article-title":"Smoking is Associated with Increased Risk of Not Achieving Glycemic Target, Increased Glycemic Variability, and Increased Risk of Hypoglycemia for People with Type 1 Diabetes","volume":"15","author":"Jensen","year":"2021","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_59","first-page":"396","article-title":"Association of smoking with the efficacy of continuous glucose monitoring in type1 diabetes: A propensity score-matched cohort study","volume":"164","author":"Marazuela","year":"2025","journal-title":"Med. Clin."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1111\/dme.14109","article-title":"Recurrent diabetic ketoacidosis and a brief history of brittle diabetes research: Contemporary and past evidence in diabetic ketoacidosis research including mortality, mental health and prevention","volume":"36","author":"Garrett","year":"2019","journal-title":"Diabet. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.2337\/dc18-0609","article-title":"Poor metabolic control in children and adolescents with type 1 diabetes and psychiatric comorbidity","volume":"41","author":"Sildorf","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s13034-023-00691-y","article-title":"Outpatient screening for anxiety and depression symptoms in adolescents with type 1 diabetes\u2014A cross-sectional survey","volume":"17","author":"Reinauer","year":"2023","journal-title":"Child Adolesc. Psychiatry Ment. Health"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/pedi.13177","article-title":"Worse glycemic control, higher rates of diabetic ketoacidosis, and more hospitalizations in children, adolescents, and young adults with type 1 diabetes and anxiety disorders","volume":"22","author":"Galler","year":"2021","journal-title":"Pediatr. Diabetes"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.2337\/dc23-2394","article-title":"Trends in Incidence of Hospitalization for Hypoglycemia and Diabetic Ketoacidosis in Individuals with Type 1 or Type 2 Diabetes With and Without Severe Mental Illness in Denmark from 1996 to 2020: A Nationwide Study","volume":"47","author":"Scheuer","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e13562","DOI":"10.1111\/eip.13562","article-title":"Exploring changing trends in depression and anxiety among adolescents from 2012 to 2019: Insights from My World repeated cross-sectional surveys","volume":"19","author":"Fitzgerald","year":"2025","journal-title":"Early Interv. Psychiatry"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e2436906","DOI":"10.1001\/jamanetworkopen.2024.36906","article-title":"Depression and Anxiety Among US Children and Young Adults","volume":"7","author":"Xiang","year":"2024","journal-title":"JAMA Netw. Open"},{"doi-asserted-by":"crossref","unstructured":"Peltier, M.R., Verplaetse, T.L., Mineur, Y.S., Petrakis, I.L., Cosgrove, K.P., Picciotto, M.R., and McKee, S.A. (2019). Sex differences in stress-related alcohol use. Neurobiol. Stress, 10.","key":"ref_67","DOI":"10.1016\/j.ynstr.2019.100149"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"52","DOI":"10.2174\/1574886315666200908110058","article-title":"Increased Risk of Falls, Fall-related Injuries and Fractures in People with Type 1 and Type 2 Diabetes\u2014A Nationwide Cohort Study","volume":"16","author":"Rasmussen","year":"2021","journal-title":"Curr. Drug Saf."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1136\/emj.2005.025627","article-title":"Children presenting to hospital with acute alcohol intoxication","volume":"23","author":"Weinberg","year":"2006","journal-title":"Emerg. Med. J."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13049-020-0707-2","article-title":"Intubation in acute alcohol intoxications at the emergency department","volume":"28","author":"Sauter","year":"2020","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.endonu.2015.02.003","article-title":"Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain","volume":"62","author":"Matei","year":"2015","journal-title":"Endocrinol. Nutr."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e016587","DOI":"10.1136\/bmjopen-2017-016587","article-title":"Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): A systematic literature review","volume":"7","author":"Brodovicz","year":"2017","journal-title":"BMJ Open"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e196","DOI":"10.2337\/dc20-1258","article-title":"An Update on the Incidence and Burden of Diabetic Ketoacidosis in the U.S","volume":"43","author":"Ramphul","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1089\/dia.2023.0149","article-title":"Prevalence, Cost, and Burden of Diabetic Ketoacidosis","volume":"25","author":"Virdi","year":"2023","journal-title":"Diabetes Technol. Ther."},{"doi-asserted-by":"crossref","unstructured":"Burcul, I., Arambasic, N., Polic, B., Kovacevic, T., Bartulovic, I., Catipovic Ardalic, T., and Markic, J. (2019). Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia. Medicina, 55.","key":"ref_75","DOI":"10.3390\/medicina55070362"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1177\/2167696817740453","article-title":"The gender risk-severity paradox for alcohol use disorder from adolescence through young adulthood","volume":"6","author":"Foster","year":"2018","journal-title":"Emerg. Adulthood"},{"unstructured":"Socidrogalcohol (2025, April 20). Estudio Sociol\u00f3gico Cualitativo Sobre el Consumo de Alcohol y Cannabis Entre Adolescentes y J\u00f3venes. Available online: https:\/\/socidrogalcohol.org\/wp-content\/Pdf\/publicaciones\/manuales-guias\/estudiosociologico-cannabis-alcohol-def.pdf.","key":"ref_77"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e15384","DOI":"10.1111\/dme.15384","article-title":"Modifiable factors to prevent severe hypoglycaemic and diabetic ketoacidosis presentations in people with type 1 diabetes","volume":"41","author":"Tamsett","year":"2024","journal-title":"Diabet. Med."},{"key":"ref_79","first-page":"1373","article-title":"Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data","volume":"6","author":"Trefan","year":"2021","journal-title":"Int. J. Popul. Data Sci."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1157\/13124995","article-title":"Predicting in-hospital mortality with coronary bypass surgery using hospital discharge data: Comparison with a prospective observational study","volume":"61","author":"Ribera","year":"2008","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_81","first-page":"61","article-title":"Changes in alcohol consumption in Spain between 1990 and 2019","volume":"34","author":"Manthey","year":"2022","journal-title":"Adicciones"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4053\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:48:30Z","timestamp":1760032110000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4053"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,8]]},"references-count":81,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14124053"],"URL":"https:\/\/doi.org\/10.3390\/jcm14124053","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,6,8]]}}}