Treating the Most Vulnerable and Costly in Diabetes

  • David V. Wagner
  • Maggie Stoeckel
  • Megan E. Tudor
  • Michael A. HarrisEmail author
Psychosocial Aspects (KK Hood and S Jaser, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Psychosocial Aspects


Diabetic ketoacidosis (DKA) is associated with negative health outcomes and high costs for patients, families, and communities. Interventions developed to effectively reduce DKA and related costs should target the multiple risk factors associated with DKA and adherence difficulties. Certain demographic, psychological, and family factors are associated with increased risk for adherence problems and DKA. Individuals with a combination of risk factors (e.g., mental health problems, low socioeconomic status, high family conflict) may be particularly vulnerable to DKA. Although several different interventions have demonstrated promise in improving adherence and/or decreasing the risk of DKA, the generalizability of treatment results to those individuals most vulnerable to DKA is limited. Approaches which include multiple evidence-based components of care, are flexible in treatment delivery (e.g., home- and community-based, utilize technology), and target the multiple risk factors across relevant systems (e.g., individual, family, school, medical) are warranted to effectively reduce DKA in vulnerable populations.


DKA Type 1 diabetes Treatment Vulnerable Risk factor Cost 



Michael A. Harris developed the NICH model and wrote the manuscript. David V. Wagner, Maggie Stoeckel, and Megan E. Tudor reviewed the literature and wrote the manuscript. Michael Harris takes responsibility for the contents of this article.

Compliance with Ethics Guidelines

Conflict of Interest

David V. Wagner, Maggie Stoeckel, Megan E. Tudor, and Michael A. Harris declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • David V. Wagner
    • 1
  • Maggie Stoeckel
    • 1
  • Megan E. Tudor
    • 2
  • Michael A. Harris
    • 1
    • 3
    Email author
  1. 1.Oregon Health & Science UniversityPortlandUSA
  2. 2.Stony Brook UniversityStony BrookUSA
  3. 3.Harold Schnitzer Diabetes Health CenterPortlandUSA

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