Kids With Type 1 Diabetes With Ketoacidosis at Diagnosis Have High HbA1c and Increased Insulin Requirement: Study

The following were the key findings:

• The study included 9,269 participants, with 54.8% males and a mean age of 9.0 years.
• Diabetic ketoacidosis (DKA) at diagnosis was identified in 34.2% of participants, with 12.8% experiencing severe DKA.
• After one year, the adjusted mean HbA1c was highest in the severe DKA group (7.41%), compared to the nonsevere DKA group (7.23%) and the no DKA group (7.14%).
• This difference remained evident after two years, with mean HbA1c levels of 7.58% in the severe DKA group, 7.38% in the nonsevere DKA group, and 7.32% in the no DKA group.
• Both DKA groups exhibited higher BMI SDS compared to those without DKA.
• Automated insulin delivery (AID) use was linked to lower HbA1c levels than other treatment methods.
• AID use also reduced the differences in HbA1c levels among the DKA groups after two years of follow-up.

"The findings suggest that both severe and nonsevere DKA at the onset of type 1 diabetes are linked to persistently elevated HbA1c levels and higher BMI SDS. However, automated insulin delivery use helps mitigate the impact of DKA at diagnosis on long-term glycemic control, reducing the differences in HbA1c levels over time," the researchers concluded.

Reference:

Klemen Dovc, Vit Neuman, Gemulla Gita, Valentino Cherubini, G. Todd Alonso, Maria Fritsch, Claudia Boettcher, Carine de Beaufort, Reinhard W. Holl, Martin de Bock; Association of Diabetic Ketoacidosis at Onset, Diabetes Technology Uptake, and Clinical Outcomes After 1 and 2 Years of Follow-up: A Collaborative Analysis of Pediatric Registries Involving 9,269 Children With Type 1 Diabetes From Nine Countries. Diabetes Care 2025; dc242483. https://doi.org/10.2337/dc24-2483