Longitudinal Predictors of Diabetic Ketoacidosis Hospitalizations and Hemoglobin A1c: Examining Adaptation to Type-1 Diabetes in Adolescents

Diabetic Ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with type-1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts. Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict number of DKA hospitalizations and HbA1c approximately one year after assessment, accounting for socio-demographics. 174 Youth 12-18 years old with T1D (M = 14.78, SD = 1.65) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c closest to 1-year follow-up. Thirty-one participants had at least one episode of DKA based on chart review. Identifying as Black/ African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up (p \u3c .05). For DKA Count, greater duration of diabetes, higher baseline HbA1c, lower income, and identifying as Non-Hispanic White and higher Youth report of internalizing symptoms were significant predictors (p \u3c 0.05). Utilizing screeners for internalizing symptoms in endocrinology clinics may be critical for early detection of youth with T1D at risk for DKA