Young Adults With T1D Show Highest Ketoacidosis Rates
In a French real-world cohort of patients with T1D, 4.5% have had at least one diabetic ketoacidosis episode in the past year, with the highest rate seen among young adults aged 18-24 years.
TOPLINE Among patients with type 1 diabetes (T1D) in a French prospective cohort, 4.5% had at least one diabetic ketoacidosis episode in the preceding year, with the highest proportion observed among adults aged 18-24 years. The use of automated insulin delivery and continuous glucose monitoring was associated with fewer episodes, and those with a recent episode more often reported severe hypoglycaemia.
METHODOLOGY Researchers conducted a retrospective, real-world analysis to estimate how often diabetic ketoacidosis occurred in patients with T1D and to identify clinical and sociodemographic characteristics associated with the episodes. They analysed data from 2685 patients in the French SFDT1 prospective cohort (mean age, 36.8 years; 51.4% male individuals) who had a study visit in 2023-2024 and were aged 7 years or older.
Patients were diagnosed with T1D between the ages of 1 and 35 years and required insulin permanently within 12 months of diagnosis. Sociodemographic and clinical data — including age, diabetes duration, most recent A1c levels, and the methods used to deliver insulin and monitor glucose — were collected.
The researchers assessed the proportion of patients with at least one physician-documented episode of diabetic ketoacidosis in the 12 months before their latest study visit. They also recorded patient-reported severe hypoglycaemia, defined as an episode needing another person's help.
TAKEAWAY Overall, 4.5% (n = 122) of patients experienced at least one diabetic ketoacidosis episode during the year before the latest study visit. By age, the highest proportion was seen among those aged 18-24 years (10.3%), compared with 6.1% at 7-13 years of age, 4.4% at 14-17 years of age, and 3.5% at 25-64 years of age.
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No episodes were recorded among those aged 65 years or older. Patients using automated insulin delivery were less likely to have an episode than those using open-loop insulin pumps (3.1% vs 5.4%; P = .034). Continuous glucose monitoring users had a lower proportion of episodes than fingerstick-only users (4.3% vs 8.1%); after adjustment, continuous glucose monitoring was associated with a 49% lower likelihood of an episode ( P = .002).
Severe hypoglycaemia episodes needing another person's help were more frequent in those with a recent ketoacidosis episode than in those without (27.0% vs 8.5%; P < .001). IN PRACTICE "The reality is that important skills in DKA [diabetic ketoacidosis] awareness and management are insufficiently emphasised in people with T1D, highlighting the ongoing need for educational reinforcement of ketone monitoring as part of personalised and data-driven diabetes management," the authors wrote.
SOURCE The study was led by Jean-Pierre Riveline, Centre Universitaire de Diabétologie et de ses Complications, AP-HP, Hôpital Lariboisière, Paris, France. It was published online on September 28, 2026, in Diabetes, Obesity and Metabolism . LIMITATIONS The sample came mostly from university hospitals and some private practices, and it did not fully represent the broader French T1D population.
Insulin therapy and glucose monitoring were recorded only at the latest study visit; therefore, any switches during the prior year were not captured. The researchers lacked detailed dates for ketoacidosis and severe hypoglycaemia episodes and information on what caused the ketoacidosis episodes, so they could not determine the sequence of events or infer cause and effect.
DISCLOSURES The SFDT1 cohort study was sponsored by the Fondation Francophone pour la Recherche sur le Diabète, with institutional funding from the Société Francophone du Diabète and the Luxembourg Institute of Health. Additional support came from Breakthrough T1D (formerly known as the Juvenile Diabetes Research Foundation), iCARE4CVD, and several pharmaceutical and medical device companies.
Support for this study within the wider cohort was provided by Abbott Diabetes Care. Several authors reported having ties with a wide range of companies, including receiving grants, consulting fees, or honoraria; serving in advisory board roles; and receiving research funding from Abbott and others.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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