Longitudinal Determination of Diabetes Complications and Other Clinical Variables as Risk Factors for Diabetic Ketoacidosis in Type 1 Diabetes
Authors' conclusion
A major cardiovascular event, foot ulcer, or amputation confers the greatest risk of future DKA independent of previously recognized risk factors, implying a need to target patients with these events for DKA prevention interventions, such as self-management skills for metabolic control, management of depression, and DKA education.
Study context
- Population
- Participants with T1D in the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study
- Participants
- 1,441 participants
- Primary endpoint
- Subsequent DKA occurrence; associations of macrovascular disease and early and late stages of neuropathy, nephropathy and retinopathy
Methodological detailslongitudinal cohort study, 34-year follow-up, multivariable Cox proportional hazards models with time-varying exposures and covariates, public data access
- Longitudinal cohort study
- 34-year follow-up
- Multivariable Cox proportional hazards models with time-varying exposures and covariates
- Public data access
Primary result
As reported in the abstract
Risk factors for DKA
Participants with diabetic ketoacidosis (DKA)
297
DKA events over follow-up
488
MACE: HR (95% CI 1.57-6.35), P = 0.001
3.16
Late-stage neuropathy (serious foot ulcer or amputation): HR (95% CI 1.04-2.45), P = 0.03
1.59
Further findings
Other clinical variables associated with higher DKA risk
- Shorter diabetes duration: HR (95% CI 0.64-0.91), P = 0.002
- 0.76
- Female sex: HR (95% CI 1.56-2.67), P < 0.001
- 2.04
- Current insulin pump use: HR (95% CI 2.29-4.02), P < 0.001
- 3.04
- Higher time-updated HbA1c, per additional 1%: HR (95% CI 1.29-1.50), P < 0.001
- 1.39
- Higher current insulin dose, per 1 additional unit/kg/day: HR (95% CI 1.62-3.33), P < 0.001
- 2.32
Original publication
Longitudinal Determination of Diabetes Complications and Other Clinical Variables as Risk Factors for Diabetic Ketoacidosis in Type 1 Diabetes. Diabetes Care. Published 14 February 2025. doi:10.
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