NON-ADHERENCE TO DIABETES MEDICATION WITH RECURRING DIABETIC KETOACIDOSIS AND SUBSEQUENT DEPRESSION: A SYSTEMATIC REVIEW

Abstract

Abdelrahman Mohamed Ahmed Abukanna*, Ahmed Hamad Ahmed Sulaiman, Mathayil Nazal Alruwaili, Ashwaq Ibrahim H Alanazi, Hala Abdullah Alanazi, Miad Daham R Alanazi, Nawaf Abdulaziz Almudiheem, Maram Saleh AL Ruwaili, Sarah Abdulqader Albalawi, Kholoud Ali Althobaiti, Amal Saeed Alzaidi and Ola Mayouf Alsufyani

Objectives: To systematically evaluate and synthesize existing evidence on the association between depression and the risk of readmission or recurrence of diabetic ketoacidosis (DKA).

Methods: A comprehensive search across four databases identified 311 publications. Duplicates were removed using Rayyan QCRI, and relevance screening reduced the selection to 40 full-text articles. After further review, five studies met the inclusion criteria.

Results: Five studies involving 615,502 participants were analyzed, with females making up 48.7% of the population. Two studies reported depression prevalence among patients with DKA, showing rates of 12.3% and 46.3%. Recurrence rates were notably high, reaching 55.4% and 50%, while readmission rates varied between 4.7% and 12.3%. Studies show a strong connection between depression and DKA readmission. Patients with depression, especially those with psychosis, are at higher risk for general and 30-day readmission. While depression is more frequent in recurrent DKA cases, its severity does not differ between single and multiple episodes. This association remains consistent over time. However, one casecontrol study found no significant difference in depression symptoms between cases and controls, indicating variability and the need for further investigation.

Conclusion: This is the first systematic review to examine the link between depression and DKA readmission or recurrence, highlighting the critical role of mental health in diabetes outcomes. Integrating depression screening and management into diabetes care may help reduce DKA episodes and improve patient outcomes. The findings support the need for enhanced mental health services as part of diabetes management. Future research should focus on longitudinal studies and standardized depression assessments to clarify this relationship and develop more effective interventions to reduce recurrent DKA.