OBJECTIVE: This study examined the association between diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis and long-term glycemic outcomes, insulin requirements, BMI SD score (SDS), and diabetes technology uptake in youth. RESEARCH DESIGN AND METHODS: Data were from nine countries (Austria, Czechia, Germany, Italy, Luxembourg, New Zealand, Slovenia, Switzerland, and U.S. [Colorado]), including youth (0.5-15.9 years) diagnosed with type 1 diabetes in 2019-2020 and followed for 2 years thereafter. Participants were divided into three groups: no DKA, nonsevere, and severe DKA at diagnosis. HbA1c, insulin requirements, BMI SDS, and use of technology, including automated insulin delivery (AID), were assessed. RESULTS: The analysis included 9,269 individuals (54.8% males, mean age 9.0 years). DKA at diagnosis was observed in 34.2% of participants and severe DKA in 12.8%. After 1 year, adjusted mean HbA1c was higher in the severe DKA group (7.41%) compared with nonsevere DKA (7.23%, P = 0.001) and no DKA groups (7.14, P < 0.001), and this difference persisted after 2 years (7.58% vs. 7.38% [P < 0.001] and vs. 7.32% [P < 0.001]). Higher BMI SDS was observed in both DKA groups compared with no DKA. The use of AID was associated with lower HbA1c levels compared with other treatment modalities and moderated differences between DKA groups after 2 years of follow-up (P = 0.072). CONCLUSIONS: Severe and nonsevere DKA at type 1 diabetes diagnosis were both associated with persistently higher HbA1c and higher BMI SDS. AID use diminishes the association of DKA at diagnosis and higher HbA1c over time.

Barbara Davis Center University of Colorado Anschutz Medical Campus Aurora CO

Department of Endocrinology Diabetes and Metabolism University Children's Hospital University Medical Centre Ljubljana and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Department of Pediatric Diabetes and Endocrinology Centre Hospitalier Luxembourg Luxembourg Luxembourg

Department of Pediatrics 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czechia

Department of Pediatrics and Adolescent Medicine Medical University Graz Graz Austria

Department of Pediatrics Faculty of Medicine and University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

Department of Pediatrics University of Otago Christchurch New Zealand

Department of Women's and Children's Health Salesi Hospital Ancona Italy

Faculty of Science Technology and Medicine University of Luxembourg Esch Belval Luxembourg

Institute of Epidemiology and Medical Biometry Munich Neuherberg Germany

Paediatric Endocrinology and Diabetology University Children's Hospital Julie von Jenner Haus University of Bern Bern Switzerland

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