France: A French prospective cohort study found that 4.5% of patients with type 1 diabetes experienced at least one episode of diabetic ketoacidosis (DKA) in the preceding year, with the highest prevalence among young adults aged 18–24 years. Use of automated insulin delivery systems and continuous glucose monitoring was associated with fewer DKA episodes. Patients with recent DKA were also more likely to report severe hypoglycaemia.

The study, published in Diabetes, Obesity and Metabolism, was conducted by Jean-Pierre Riveline, Centre Universitaire de Diabétologie et de ses Complications, AP-HP, Hôpital Lariboisière, Paris, France, and colleagues. The researchers assessed the real-world burden of DKA and examined the clinical and sociodemographic characteristics of people with type 1 diabetes (T1D) in France.
DKA is a potentially life-threatening complication that develops when insufficient insulin causes the body to break down fat for energy, resulting in the accumulation of ketones and blood acidity. Despite advances in diabetes technology, preventing DKA remains an important challenge in T1D management.
The analysis included 2,685 participants from the French SFDT1 cohort, with data collected during their most recent study visits between January 2023 and December 2024. Participants had a mean age of 36.8 years, a mean age at diabetes diagnosis of 16.1 years, and an average disease duration of 20.7 years. The researchers assessed DKA episodes and severe hypoglycaemic events during the preceding 12 months.
The key findings were:
  • Overall DKA burden: A total of 4.5% of participants experienced at least one DKA episode in the previous year.
  • Young adults at greatest risk: DKA was most prevalent among those aged 18–24 years, affecting 10.3% of this age group. Younger age, earlier diabetes onset, shorter disease duration, and higher HbA1c levels were also associated with DKA.
  • Automated insulin delivery: Participants using automated insulin delivery systems had a lower DKA prevalence than those using open-loop insulin delivery systems (3.1% versus 5.4%).
  • Continuous glucose monitoring: DKA was less frequent among continuous glucose monitoring users than among those relying on self-monitoring of blood glucose (4.3% versus 8.1%).
  • Severe hypoglycaemia: Participants with recent DKA were more likely to experience severe hypoglycaemic events than those without DKA (27.0% versus 8.5%).
The researchers noted that the findings highlight the continuing burden of DKA, even among people using advanced diabetes technologies. However, the observational design does not establish that automated insulin delivery or continuous glucose monitoring directly prevents DKA.
The study also had limitations. Participants were recruited mainly from university hospitals and selected private practices and may not fully represent the broader French T1D population. Changes in treatment or glucose-monitoring methods during the assessment period were not captured, and the absence of detailed information on DKA triggers limited the identification of specific causes.
The authors concluded that young adults with T1D require particular attention to DKA prevention, including education on ketone monitoring, early recognition of warning signs, and appropriate diabetes management. They also emphasised the need to reinforce strategies to prevent both DKA and severe hypoglycaemia.
Reference: https://doi.org/10.1111/dom.71383
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Article Source : Diabetes Obesity and Metabolism

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Medha Baranwal

Medha Baranwal holds a Bachelor’s degree in Biomedical Sciences from the University of Delhi and a Master’s degree in Biotechnology from Amity University. Since May 2018, she has been contributing to Medical Dialogues, writing and editing medical news articles that translate complex research into clear, accessible information for healthcare professionals.

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