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Internal Medicine›Condition·Updated Apr 17, 2026·v1

DKA Claude

DKA is a metabolic emergency requiring immediate recognition and treatment with IV insulin, balanced crystalloid resuscitation, and electrolyte replacement. Early basal insulin administration significantly improves outcomes. Key monitoring includes glucose, ketones, anion gap, and neurological status. Treatment continues until resolution criteria are met, followed by careful transition to subcutaneous insulin with diabetes education and follow-up.

High Evidence180 references·817 words·4 min read·v1
emergency_medicineendocrinologymetabolic_emergencydiabetesketoacidosisinsulincritical_care

Quick Reference

RxDrug of choiceIV insulin infusion 0.1 units/kg/hour + early basal insulin (glargine 0.3 units/kg SC)
AltAlternativesSubcutaneous insulin protocol (SQuID) for mild DKA: glargine 0.25 units/kg + aspart 0.15 units/kg q2h
⊘AvoidSodium bicarbonate (unless pH <6.9), SGLT-2 inhibitors during active DKA, insulin boluses >0.1 units/kg
DxTest of choiceArterial blood gas + anion gap calculation, blood ketones (β-hydroxybutyrate preferred over urine)
ScKey scoreDKA severity: mild (pH 7.25-7.30), moderate (pH 7.0-7.24), severe (pH <7.0) - severe requires ICU
→When to referSevere DKA (pH <7.1), altered mental status, hemodynamic instability, age <2 years, recurrent episodes
Life-threatening metabolic emergency requiring immediate IV insulin, fluid resuscitation with balanced crystalloids, and aggressive electrolyte replacement. Early basal insulin reduces resolution time. Monitor for cerebral edema in children.
Diabetic ketoacidosis (DKA) is a life-threatening metabolic emergency characterized by hyperglycemia, ketosis, and metabolic acidosis. It occurs primarily in patients with type 1 diabetes but can affect those with type 2 diabetes under stress conditions. DKA results from absolute or relative insulin deficiency leading to uncontrolled lipolysis, ketogenesis, and gluconeogenesis.

Overview and Recommendations

Background

  • •DKA is a metabolic emergency caused by absolute or relative insulin deficiency, resulting in hyperglycemia (typically >250 mg/dL), ketosis (β-hydroxybutyrate >3.0 mmol/L), and metabolic acidosis (pH <7.3, bicarbonate <15 mEq/L). The condition occurs when insulin deficiency triggers uncontrolled lipolysis and ketogenesis.
  • •Type 1 diabetes accounts for the majority of DKA cases, but type 2 diabetes patients can develop DKA during severe stress, illness, or with certain medications. can cause euglycemic DKA where glucose levels may be normal or only mildly elevated.
  • •Common precipitants include infection (most common), medication non-adherence, new-onset diabetes, cardiovascular events, and psychological stress. Up to 30% of cases occur at initial diabetes diagnosis, particularly in children under 2 years who have the highest risk of severe presentation.
  • •Mortality ranges from 1-5% in developed countries but remains higher in resource-limited settings. Complications include cerebral edema (particularly in children), cardiovascular collapse, acute kidney injury, and electrolyte disturbances.
  • •The classic triad of polyuria, polydipsia, and weight loss may be preceded by nausea, vomiting, abdominal pain, and altered mental status. Kussmaul respirations (deep, rapid breathing) represent compensatory hyperventilation for metabolic acidosis.

Evaluation

  • •Suspect DKA in any patient with diabetes presenting with nausea, vomiting, abdominal pain, or altered mental status. Maintain high suspicion in patients taking even with normal glucose levels (euglycemic DKA).
  • •Obtain immediate point-of-care glucose and ketones (blood ketones preferred over urine). Blood glucose >250 mg/dL with ketones >1.5 mmol/L strongly suggests DKA, but euglycemic variants exist.
  • •Order arterial blood gas immediately - pH <7.3 with anion gap >12 mEq/L confirms metabolic acidosis. Calculate anion gap: [Na+] - ([Cl-] + [HCO3-]). Normal anion gap is 8-12 mEq/L.
  • •Assess severity using pH and bicarbonate: mild DKA (pH 7.25-7.30, HCO3- 15-18 mEq/L), moderate DKA (pH 7.0-7.24, HCO3- 10-14 mEq/L), severe DKA (pH <7.0, HCO3- <10 mEq/L). Severe DKA requires ICU admission.
  • •Evaluate hemodynamic status carefully - patients often present with significant dehydration and may have hypotension (systolic BP <90 mmHg). Assess for signs of shock including tachycardia, poor capillary refill, and altered mental status.
  • •Perform comprehensive metabolic panel including electrolytes, BUN, creatinine, and phosphorus. Check serum osmolality if concerned for concurrent . Obtain CBC to evaluate for infection or hemoconcentration.
  • •Assess neurological status using Glasgow Coma Scale and examine for signs of cerebral edema (headache, altered mental status, focal deficits). Children and young adults have highest risk for this life-threatening complication.
  • •Identify precipitating factors through history and examination: recent illness, medication changes, insulin omission, new stressors. Obtain cultures (blood, urine) if infection suspected. Consider cardiac evaluation if chest pain or ECG changes present.
  • •Monitor for concurrent conditions: (subcutaneous emphysema), (nasal lesions), or other serious infections that may complicate DKA and require immediate intervention.
  • •Document baseline vital signs, mental status, and fluid balance for monitoring treatment response. Establish IV access (preferably two large-bore IVs) and consider central access for severe cases or difficult peripheral access.

Management

  • •Initiate IV insulin infusion at 0.1 units/kg/hour after confirming serum potassium >3.3 mEq/L. Do not give insulin bolus routinely as it provides no additional benefit and increases hypoglycemia risk.
  • •Begin fluid resuscitation with 15-20 mL/kg IV bolus over first hour. Balanced crystalloids are superior to normal saline, reducing time to DKA resolution and preventing hyperchloremic acidosis.
  • •Administer early basal insulin (glargine 0.3 units/kg subcutaneously) within 3 hours of diagnosis. This intervention reduces DKA resolution time from 10.2 to 6.8 hours and decreases rebound hyperglycemia.
  • •Replace potassium aggressively: if K+ 3.3-5.2 mEq/L, add 20-30 mEq KCl per liter of IV fluid. If K+ <3.3 mEq/L, hold insulin until corrected and give 40 mEq KCl. Monitor every 2 hours initially.
  • •Switch to dextrose-containing fluids (D5 lactated Ringer's) when glucose falls below 250 mg/dL to prevent hypoglycemia while continuing insulin to clear ketones. Reduce insulin infusion to 0.05 units/kg/hour at this point.
  • •Monitor glucose, electrolytes, and anion gap every 2 hours initially. Target glucose decline of 50-75 mg/dL per hour. Maintain glucose 150-250 mg/dL during active treatment to allow continued ketone clearance.
  • •Avoid sodium bicarbonate unless pH <6.9, as it increases cerebral edema risk and delays ketone clearance. When indicated, give 100 mEq in 400 mL sterile water over 2 hours.
  • •Continue treatment until DKA resolution: anion gap <12 mEq/L, bicarbonate >15 mEq/L, pH >7.30, and ketones <0.6 mmol/L. Patient must also be alert and able to tolerate oral intake.
  • •Transition to subcutaneous insulin when resolution criteria met: calculate total daily dose (0.5-0.8 units/kg/day), give 50% as basal and 50% as prandial insulin. Continue IV insulin for 1-2 hours after first subcutaneous dose.
  • •Admit severe DKA (pH <7.1) to ICU. Mild-moderate DKA can be managed on medical floors with appropriate protocols. Consider subcutaneous insulin protocols (SQuID) for mild DKA in stable patients.
  • •Identify and treat precipitating factors: start antibiotics for suspected infection, review medication adherence, address psychosocial stressors. Discontinue if present.
  • •Provide diabetes education before discharge: sick day management, ketone monitoring, when to seek care, medication adherence. Arrange endocrinology follow-up within 1-2 weeks and ensure access to glucose/ketone monitoring supplies.
  • •Monitor for complications: cerebral edema (especially in children), acute kidney injury, cardiac arrhythmias from electrolyte shifts, and treatment-related hypoglycemia or hypokalemia.
  • •Consider continuous glucose monitoring initiation before discharge to reduce future DKA risk. Patients with recurrent DKA benefit from diabetes technology and intensive management programs.

Board Review — High Yield

  • •Euglycemic DKA — occurs with SGLT-2 inhibitors, pregnancy, or starvation; glucose may be normal but ketones and acidosis present
  • •Kussmaul respirations — deep, rapid breathing compensating for metabolic acidosis; do not suppress with sedation
  • •Cerebral edema — most feared complication in children; presents with headache, altered mental status, bradycardia with hypertension
  • •Early basal insulin — glargine 0.3 units/kg within 3 hours reduces DKA resolution time by 3-4 hours
  • •Lactated Ringer's superior — to normal saline for DKA; faster anion gap closure and less hyperchloremic acidosis
  • •Potassium replacement critical — insulin drives K+ intracellularly; hold insulin if K+ <3.3 mEq/L
  • •Bicarbonate contraindicated — unless pH <6.9; increases cerebral edema risk and delays ketone clearance
  • •Resolution criteria — anion gap <12, HCO3- >15, pH >7.30, ketones <0.6 mmol/L, alert mental status
  • •Insulin transition — continue IV insulin 1-2 hours after first subcutaneous dose to prevent rebound ketosis

Deep Dive — Evidence Details

References

  1. [1]

    Yan JW, Woods N, Van Aarsen K et al.. “Predictors of 30-Day Recurrent Emergency Department Visits for Hyperglycemia in Patients With Diabetes: A Multicentre Prospective Cohort Study.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2025). PMID: 40859828 ↗

    L2bCOHORTCited in: Recognition and Triage
  2. [2]

    Williams K, Suh JM, Raykateeraroj N et al.. “Characteristics and outcomes of diabetes emergencies in nonagenarians admitted to ICU: a binational retrospective cohort study.” Frontiers in clinical diabetes and healthcare (2026). PMID: 41890348 ↗

    L2bCOHORTCited in: Recognition and Triage, Monitoring and Disposition
  3. [3]

    Martínez-Brocca MA, Bellido V, Cardona-Hernandez R et al.. “Executive summary. Screening, staging and follow-up of type 1 diabetes in preclinical stages: consensus of the scientific societies SED, SEEN and SEEP.” Anales de pediatria (2025). PMID: 41266045 ↗

    L1cGUIDELINECited in: Recognition and Triage
  4. [4]

    Stathi D, Lee FN, Dhar M et al.. “Diabetic Ketoacidosis in Pregnancy: A Systematic Review of the Reported Cases.” Clinical medicine insights. Endocrinology and diabetes (2025). PMID: 39822589 ↗

    L2aSR_OBSCited in: Recognition and Triage
  5. [5]

    Joseph JF, Bischoff K. “Bedside guillotine foot and ankle amputation in the emergency department due to necrotizing fasciitis.” The American journal of emergency medicine (2026). PMID: 41076347 ↗

    L4CASE_REPORTCited in: Recognition and Triage, Immediate Assessment (ABCs)
  6. [6]

    Ruiz-Urbaez R, Males-Maldonado D, Villagómez-Estrada MV et al.. “Case Report: Misdiagnosis of Maturity-Onset Diabetes of the Young as type 1, type 2 or gestational diabetes: insights from a Latin American tertiary center.” Frontiers in medicine (2025). PMID: 41020216 ↗

    L4CASE_REPORTCited in: Recognition and Triage
  7. [7]

    Luo S, Tian X, Xu T et al.. “Case Report: Liquid-based cytology diagnosis of pulmonary mucormycosis.” Frontiers in medicine (2025). PMID: 40771474 ↗

    L4CASE_REPORTCited in: Recognition and Triage
  8. [8]

    Mameli C, Macedoni M, Redaelli F et al.. “Case Report: Usefulness, effectiveness, and safety of an advanced hybrid closed-loop system in a child with early identification of type 1 diabetes.” Frontiers in endocrinology (2025). PMID: 40529832 ↗

    L4CASE_REPORTCited in: Recognition and Triage
  9. [9]

    Egli L, Hollinger A, Leuppi-Taegtmeyer A et al.. “Acute Esophageal Necrosis Associated with Alcoholic Ketoacidosis A Case Report.” Journal of intensive care medicine (2025). PMID: 40375802 ↗

    L4CASE_REPORTCited in: Recognition and Triage
  10. [10]

    Karakus KE, Clayton MG, Baschal EE et al.. “Differences in Clinical Manifestations and Islet Autoantibodies by Age in Adult-Onset Type 1 Diabetes.” Diabetes care (2026). PMID: 41925716 ↗

    L5OTHERCited in: Recognition and Triage
  11. [11]

    Löffler S, Frigo F, Hochfellner D et al.. “Clinical Characteristics and Predictors of Glycemic Control During the First 24 Months After Diagnosis of Type 1 Diabetes.” Biomedicines (2026). PMID: 41898334 ↗

    L5OTHERCited in: Recognition and Triage, Special Populations
  12. [12]

    Yan H, Lv J, Miao L et al.. “Analysis of risk factors and establishment of a prediction model for latent autoimmune diabetes in adults.” Therapeutic advances in endocrinology and metabolism (2026). PMID: 41800074 ↗

    L5OTHERCited in: Recognition and Triage
  13. [13]

    Lee HS, Kim HY, Yang M et al.. “Familial Occurrence of Type 1 Diabetes Mellitus in Korean Children and Adolescents: A Multicenter Study.” Diabetes & metabolism journal (2026). PMID: 41782396 ↗

    L5OTHERCited in: Recognition and Triage
  14. [14]

    Katte JC, Bavuma C, Wild SH et al.. “Atypical diabetes subtypes in Black African populations.” Diabetologia (2026). PMID: 41770244 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  15. [15]

    Samie S, Sajadi M, Moradzadeh R et al.. “Self-care needs and obstacles of adolescents with type 1 diabetes: a narrative review.” Diabetology & metabolic syndrome (2026). PMID: 41715145 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  16. [16]

    Lan YY, Kovinthapillai R, Kędzia A et al.. “Enhancing Primary Care Recognition of Type 1 Diabetes in Children: Diagnostic Challenges and Strategies to Prevent Diabetic Ketoacidosis.” Journal of clinical medicine (2026). PMID: 41598470 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  17. [17]

    Małachowska M, Kosiorowski K, Pokrywka P et al.. “INNODIA screening for early-stage type 1 diabetes: Insights from Polish first-degree relatives of T1D patients (2015-2023, EU115797).” Advances in clinical and experimental medicine : official organ Wroclaw Medical University (2026). PMID: 41528838 ↗

    L5OTHERCited in: Recognition and Triage
  18. [18]

    Muzslay E, Herczeg V, Pusztai RI et al.. “Overweight worsens the metabolic presentation of type 1 diabetes mellitus in children.” Frontiers in endocrinology (2025). PMID: 41585812 ↗

    L5OTHERCited in: Recognition and Triage
  19. [19]

    Schönberger E, Švitek L, Grubišić B et al.. “Beyond Tumor Immunity: The Disruption of Endocrine and Infectious Homeostasis by Immune Checkpoint Inhibitors.” International journal of molecular sciences (2025). PMID: 41373773 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  20. [20]

    Niechciał E, Bielecki M, Geppert A et al.. “Assessment of the clinical severity of new-onset type 1 diabetes in children and adolescents from Greater Poland province, Poland: a retrospective cross-sectional study.” BMJ open (2025). PMID: 41083307 ↗

    L5OTHERCited in: Recognition and Triage
  21. [21]

    Ladak Z, Medeiros P, Rouleau G et al.. “Identifying Potential Sustainable and Scalable Interventions to Recognize Signs of Diabetes in Children Across Canada.” Canadian journal of diabetes (2025). PMID: 40976280 ↗

    L5OTHERCited in: Recognition and Triage
  22. [22]

    Gün M. “Can AI match emergency physicians in managing common emergency cases? A comparative performance evaluation.” BMC emergency medicine (2025). PMID: 40745532 ↗

    L5OTHERCited in: Recognition and Triage, Immediate Assessment (ABCs)
  23. [23]

    Gün M. “AI-Assisted Blood Gas Interpretation: A Comparative Study With an Emergency Physician.” The American journal of emergency medicine (2025). PMID: 40252296 ↗

    L5REVIEW_NARRATIVECited in: Recognition and Triage
  24. [24]

    Karume AK, Sugut J, Sankei P et al.. “Improvement in clinician confidence in and knowledge of Diabetic Ketoacidosis management following a case-based curriculum in Kenya.” BMC medical education (2025). PMID: 40057747 ↗

    L5OTHERCited in: Recognition and Triage
  25. [25]

    Jia G, Yang C, Feng Y. “Diabetes-associated central nervous system mucormycosis with delayed diagnosis: a case report.” Frontiers in neurology (2025). PMID: 40395765 ↗

    L4CASE_REPORTCited in: Recognition and Triage
  26. [26]

    Trainor JL, Glaser NS, Tzimenatos L et al.. “Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis.” Annals of emergency medicine (2023). PMID: 37024382 ↗

    L1bRCTCited in: Immediate Assessment (ABCs)
  27. [27]

    Beccia C, Hunter B, Birkic V et al.. “Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful? A systematic review protocol.” BMJ open (2023). PMID: 38159949 ↗

    L2aSR_OBSCited in: Immediate Assessment (ABCs), Primary Management Algorithm
  28. [28]

    Koyama K, Anno T, Kimura Y et al.. “Pathology of Ketoacidosis in Emergency of Diabetic Ketoacidosis and Alcoholic Ketoacidosis: A Retrospective Study.” Journal of diabetes research (2024). PMID: 38225984 ↗

    L2bCOHORTCited in: Immediate Assessment (ABCs)
  29. [29]

    Frontino G, Di Tonno R, Castorani V et al.. “Non-Occlusive Mesenteric Ischemia in Children With Diabetic Ketoacidosis: Case Report and Review of Literature.” Frontiers in endocrinology (2022). PMID: 35928892 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  30. [30]

    Tseng YS, Swaney N, Cashen K et al.. “Nephrogenic diabetes insipidus with new onset diabetic ketoacidosis in a child - challenges in fluid and electrolyte management.” Pediatric nephrology (Berlin, Germany) (2022). PMID: 35286454 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  31. [31]

    Foughty ZC, Moryan-Blanchard K, Henkel EB et al.. “Hyperosmolar hyperglycemic coma in an infant with neonatal diabetes mellitus.” The American journal of emergency medicine (2022). PMID: 34756479 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  32. [32]

    Deng B, Liu W, Chu Q. “The SGLT2 inhibitor checklist: a comprehensive review of perioperative and acute phase safety management.” Frontiers in endocrinology (2026). PMID: 41757229 ↗

    L5REVIEW_NARRATIVECited in: Immediate Assessment (ABCs)
  33. [33]

    Tomita D, Bamba Y, Kuwabara N et al.. “A Case of Concurrent Metformin-Associated Lactic Acidosis and Euglycemic Diabetic Ketoacidosis.” The Journal of emergency medicine (2025). PMID: 40537294 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  34. [34]

    Wu C, Kambhatla S, Zazaian A et al.. “Pleiotropic Effects of Cocaine Abuse in Hyperglycemic Crisis: Main Culprit or Accomplice but Never an Innocent Bystander.” Clinical medicine insights. Endocrinology and diabetes (2025). PMID: 40520941 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  35. [35]

    Eraky AM, Yerramalla Y, Khan A et al.. “Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review.” Journal of clinical medicine (2024). PMID: 39768744 ↗

    L5REVIEW_NARRATIVECited in: Immediate Assessment (ABCs)
  36. [36]

    Hay RE, Parsons SJ, Wade AW. “The effect of dehydration, hyperchloremia and volume of fluid resuscitation on acute kidney injury in children admitted to hospital with diabetic ketoacidosis.” Pediatric nephrology (Berlin, Germany) (2024). PMID: 37733096 ↗

    L5OTHERCited in: Immediate Assessment (ABCs)
  37. [37]

    Malkan R, Baillio M, Gao HT et al.. “Elevated Osmolal Gap in a Case of Multiple Myeloma.” The Journal of emergency medicine (2024). PMID: 38403563 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  38. [38]

    Atiase Y, Yorke E, Akpalu J et al.. “Clinical characteristics and severity of diabetic ketoacidosis: A cross-sectional study from a tertiary hospital in Ghana.” Tropical medicine & international health : TM & IH (2023). PMID: 37537727 ↗

    L5OTHERCited in: Immediate Assessment (ABCs)
  39. [39]

    Loh KH, Kelley JC, Eagle SS. “Intraoperative diagnosis of type 1 diabetes and diabetic ketoacidosis during scoliosis surgery.” Paediatric anaesthesia (2023). PMID: 37128678 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  40. [40]

    Svensson R, Hahn RG, Zdolsek JH et al.. “Plasma volume expansion reveals hidden metabolic acidosis in patients with diabetic ketoacidosis.” Intensive care medicine experimental (2022). PMID: 36038699 ↗

    L5OTHERCited in: Immediate Assessment (ABCs)
  41. [41]

    Pawar RD, Balaji L, Grossestreuer AV et al.. “Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study.” Annals of internal medicine (2022). PMID: 34871057 ↗

    L5OTHERCited in: Immediate Assessment (ABCs)
  42. [42]

    Rajasegaran VP, Tamilarasan P, Kalaimani T. “Diabetic ketoacidosis masquerading behind alkalemia an undiagnosed or missed variant of diabetic ketoacidosis.” Journal of pediatric endocrinology & metabolism : JPEM (2022). PMID: 35844096 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  43. [43]

    Luo X, Ji R, Lu W et al.. “Dapagliflozin-Associated Euglycemic Diabetic Ketoacidosis in a Patient Who Underwent Surgery for Pancreatic Carcinoma: A Case Report.” Frontiers in surgery (2022). PMID: 35284482 ↗

    L4CASE_REPORTCited in: Immediate Assessment (ABCs)
  44. [44]

    Lei M, Lin B, Ling P et al.. “Efficacy and safety of Android artificial pancreas system use at home among adults with type 1 diabetes mellitus in China: protocol of a 26-week, free-living, randomised, open-label, two-arm, two-phase, crossover trial.” BMJ open (2023). PMID: 37558445 ↗

    L2bTRIAL_NONRANDOMCited in: Primary Management Algorithm
  45. [45]

    Lim BL, Lee WF, Lee B et al.. “Subcutaneous fast-acting insulin analogues, alone or in combination with long-acting insulin, versus intravenous regular insulin infusion in patients with diabetic ketoacidosis: protocol for an updated systematic review and meta-analysis of randomised trials.” BMJ open (2023). PMID: 36764729 ↗

    L2bTRIAL_NONRANDOMCited in: Primary Management Algorithm
  46. [46]

    Ludvigsson J, Eriksson L, Nowak C et al.. “Phase III, randomised, double-blind, placebo-controlled, multicentre trial to evaluate the efficacy and safety of rhGAD65 to preserve endogenous beta cell function in adolescents and adults with recently diagnosed type 1 diabetes, carrying the genetic HLA DR3-DQ2 haplotype: the DIAGNODE-3 study protocol.” BMJ open (2022). PMID: 36316084 ↗

    L2bTRIAL_NONRANDOMCited in: Primary Management Algorithm, Pharmacotherapy
  47. [47]

    Gübeli A, Steiner N, Limacher A et al.. “Dapagliflozin's impact on hormonal regulation and ketogenesis in type 1 diabetes: a randomised controlled crossover trial.” Diabetologia (2025). PMID: 40629004 ↗

    L1bRCTCited in: Primary Management Algorithm
  48. [48]

    Garabedian C, Sénat MV, Sananès N et al.. “[Preexisting diabetes: Expert consensus from the College of French Gynecologists and Obstetricians and from the French Society of Diabetology].” Gynecologie, obstetrique, fertilite & senologie (2026). PMID: 41365423 ↗

    L1cGUIDELINECited in: Primary Management Algorithm, Pharmacotherapy, Secondary Assessment, Special Populations, Guidelines and Resources
  49. [49]

    De Meulemeester J, Valgaerts L, Tenoutasse S et al.. “One-year effectiveness and safety in young children aged 2-6 years with type 1 diabetes using an automated insulin delivery system: A real-world prospective cohort study.” Diabetes, obesity & metabolism (2026). PMID: 41144887 ↗

    L2bCOHORTCited in: Primary Management Algorithm
  50. [50]

    Qiang JK, Kiss A, Yu W et al.. “Safety and Effectiveness of Subcutaneous Insulin for Management of Mild to Moderate Diabetic Ketoacidosis in Nonpregnant Individuals: A Retrospective Cohort Study at a Tertiary Care Centre.” Canadian journal of diabetes (2026). PMID: 41138813 ↗

    L2bCOHORTCited in: Primary Management Algorithm
  51. [51]

    Fragozo-Ramos MC, Schenker G, Hepprich M et al.. “GIP/GLP-1RA as adjunctive to automated insulin delivery in adults with Type 1 diabetes (the AID-JUNCT trial): Study protocol for a prospective, randomized, clinical trial.” PloS one (2025). PMID: 41124171 ↗

    L2bTRIAL_NONRANDOMCited in: Primary Management Algorithm, Pharmacotherapy, Secondary Assessment
  52. [52]

    Trifi A, Ben Braik I, Galai H et al.. “0.9% sodium chloride versus ringer's lactate in the management of severe diabetic ketoacidosis: A randomized trial.” Medicina intensiva (2026). PMID: 40234173 ↗

    L1bRCTCited in: Primary Management Algorithm, Pharmacotherapy
  53. [53]

    Chen Y, Zhu W, Chen G et al.. “Successful rapid desensitization to multiple insulin preparations in an adult with type 1 diabetes: a case report and literature review.” Frontiers in endocrinology (2026). PMID: 41625952 ↗

    L4CASE_REPORTCited in: Primary Management Algorithm
  54. [54]

    Yoo MS, Daniels A, Maslow RA et al.. “Management of hospitalized patients with mild to moderate diabetic ketoacidosis using a continuous insulin infusion protocol on a medical surgical ward and observation level of care: A retrospective cohort study.” Medicine (2022). PMID: 35945801 ↗

    L2bCOHORTCited in: Primary Management Algorithm
  55. [55]

    Ho MKH, Santhireswaran A, Gomes T et al.. “Comparative effectiveness and safety of insulin reference biologics versus biosimilars for types 1 and 2 diabetes mellitus: Protocol for a systematic review of real-world studies.” PloS one (2025). PMID: 40737300 ↗

    L2aSR_OBSCited in: Primary Management Algorithm
  56. [56]

    Girardi M, Griffey RT, Schneider RM et al.. “Putting SQuID on the menu: A subcutaneous insulin protocol for diabetic ketoacidosis.” Journal of hospital medicine (2026). PMID: 40686034 ↗

    L5OTHERCited in: Primary Management Algorithm
  57. [57]

    Campana C, Heaney A, Ceraolo N et al.. “Tirzepatide-Associated Euglycemic Diabetic Ketoacidosis in the Absence of Sodium-Glucose Cotransporter-2 Inhibitor Use: A Case Report.” The Journal of emergency medicine (2026). PMID: 41747466 ↗

    L4CASE_REPORTCited in: Primary Management Algorithm
  58. [58]

    Cardona Z, Friedman JG, Kamal N et al.. “Developing a Protocol for Management of Euglycemic Diabetic Ketoacidosis.” Current diabetes reports (2025). PMID: 40900206 ↗

    L5REVIEW_NARRATIVECited in: Primary Management Algorithm, Pharmacotherapy
  59. [59]

    Baddock S, Raven L, Abeygunasekara G et al.. “Management of diabetic ketoacidosis in adult inpatients: A retrospective analysis of rates of hypoglycaemia with variable-rate and fixed-rate intravenous insulin infusion protocols.” Diabetic medicine : a journal of the British Diabetic Association (2025). PMID: 40312766 ↗

    L5OTHERCited in: Primary Management Algorithm
  60. [60]

    Sharma A, Rengarajan L, Narendran P et al.. “Guidelines for the management of diabetes-related ketoacidosis (DKA) have been poorly adopted and implemented, resulting in a lack of improvement in outcomes.” Diabetic medicine : a journal of the British Diabetic Association (2025). PMID: 39928758 ↗

    L5OTHERCited in: Primary Management Algorithm
  61. [61]

    Tillman JB, Beck RW, Polonsky WH et al.. “Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis.” The Journal of clinical endocrinology and metabolism (2025). PMID: 39546625 ↗

    L5OTHERCited in: Primary Management Algorithm
  62. [62]

    Griffey RT, Schneider RM, Girardi M et al.. “SQuID (subcutaneous insulin in diabetic ketoacidosis): Clinician acceptability.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2025). PMID: 39313955 ↗

    L5OTHERCited in: Primary Management Algorithm
  63. [63]

    Griffey RT, Schneider RM, Girardi M et al.. “SQuID (subcutaneous insulin in diabetic ketoacidosis) II: Clinical and operational effectiveness.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2025). PMID: 39308229 ↗

    L5OTHERCited in: Primary Management Algorithm
  64. [64]

    Jozwiak M, Hayes MM, Canet E et al.. “Management of diabetic keto-acidosis in adult patients admitted to intensive care unit: an ESICM-endorsed international survey.” Critical care (London, England) (2024). PMID: 39695701 ↗

    L5OTHERCited in: Primary Management Algorithm
  65. [65]

    Jamison A, Mohamed A, Chedester C et al.. “Lactated Ringer's versus normal saline in the management of acute diabetic ketoacidosis (RINSE-DKA).” Pharmacotherapy (2024). PMID: 39077895 ↗

    L5OTHERCited in: Primary Management Algorithm
  66. [66]

    Johnson J, Drincic A, Buddenhagen E et al.. “Evaluation of a Protocol Change Promoting Lactated Ringers Over Normal Saline in the Treatment of Diabetic Ketoacidosis.” Journal of diabetes science and technology (2024). PMID: 38454546 ↗

    L5OTHERCited in: Primary Management Algorithm
  67. [67]

    Elian V, Popovici V, Karampelas O et al.. “Risks and Benefits of SGLT-2 Inhibitors for Type 1 Diabetes Patients Using Automated Insulin Delivery Systems-A Literature Review.” International journal of molecular sciences (2024). PMID: 38396657 ↗

    L5REVIEW_NARRATIVECited in: Primary Management Algorithm
  68. [68]

    Sharma P, Vyas V, Didel S et al.. “A new onset drug induced diabetes mellitus presenting with diabetic ketoacidosis in a child undergoing treatment for B cell acute lymphoblastic leukemia. A case report and review of literature.” Journal of pediatric endocrinology & metabolism : JPEM (2024). PMID: 38281148 ↗

    L4CASE_REPORTCited in: Primary Management Algorithm
  69. [69]

    Brown KM, Glaser NS, McManemy JK et al.. “Rehydration Rates and Outcomes in Overweight Children With Diabetic Ketoacidosis.” Pediatrics (2023). PMID: 37920947 ↗

    L5OTHERCited in: Primary Management Algorithm
  70. [70]

    Lalani B, Gosselin K, Penno R et al.. “A Retrospective Cohort Analysis of Two Computerized Insulin Infusion Protocols.” Journal of diabetes science and technology (2023). PMID: 36946553 ↗

    L5OTHERCited in: Primary Management Algorithm
  71. [71]

    Griffey RT, Schneider RM, Girardi M et al.. “The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2023). PMID: 36775281 ↗

    L5OTHERCited in: Primary Management Algorithm
  72. [72]

    Brown M, Roberts J, Smith C et al.. “Safety and Effectiveness of the Use of an Electronic Glucose Monitoring System Versus Weight-Based Dosing Nomogram for Treatment of Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome in a VA Hospital.” Journal of diabetes science and technology (2023). PMID: 35128975 ↗

    L5OTHERCited in: Primary Management Algorithm
  73. [73]

    Nan J, Wang D, Zhong R et al.. “Sodium glucose cotransporter2 inhibitors for type 1 diabetes mellitus: A meta-analysis of randomized controlled trials.” Primary care diabetes (2024). PMID: 37980217 ↗

    L1aSR_MA_RCTCited in: Pharmacotherapy
  74. [74]

    Thammakosol K, Jantarapootirat M, Traiwanatham S et al.. “Early insulin degludec with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial.” Diabetes, obesity & metabolism (2025). PMID: 40903851 ↗

    L1bRCTCited in: Pharmacotherapy
  75. [75]

    El Feky AY, Abdou MS, Naguib R et al.. “Effectiveness and Safety of Early Insulin Glargine U100 and Glargine U300 Administration in the Management of Diabetic Ketoacidosis in Adults With Type 1 Diabetes Mellitus: A Randomized Clinical Trial.” Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (2025). PMID: 40840711 ↗

    L1bRCTCited in: Pharmacotherapy
  76. [76]

    Hawary AE, Sobh A, Elsharkawy A et al.. “Assessment of the use of long-acting insulin in management of diabetic ketoacidosis in pediatric patients: a randomized controlled trial.” Annals of pediatric endocrinology & metabolism (2025). PMID: 39778214 ↗

    L1bRCTCited in: Pharmacotherapy
  77. [77]

    Elbarbary NS, Ismail EA, El-Hamamsy MH et al.. “The DPP-4 inhibitor sitagliptin improves glycaemic control and early-stage diabetic nephropathy in adolescents with type 1 diabetes using the MiniMed 780G advanced hybrid closed-loop system: a randomised controlled trial.” Diabetologia (2024). PMID: 39271520 ↗

    L1bRCTCited in: Pharmacotherapy
  78. [78]

    Niessen SJM, Kooistra HS, Forcada Y et al.. “Efficacy and safety of once daily oral administration of sodium-glucose cotransporter-2 inhibitor velagliflozin compared with twice daily insulin injection in diabetic cats.” Journal of veterinary internal medicine (2024). PMID: 38884190 ↗

    L1bRCTCited in: Pharmacotherapy
  79. [79]

    Nally LM, Sherr JL, Tichy E et al.. “Impact of school-supervised ultra-long-acting basal insulin injections on ketosis in youth with T1D and elevated haemoglobin A1c: A pilot study.” Diabetic medicine : a journal of the British Diabetic Association (2023). PMID: 37078999 ↗

    L1bRCTCited in: Pharmacotherapy
  80. [80]

    Thammakosol K, Sriphrapradang C. “Effectiveness and safety of early insulin glargine administration in combination with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial.” Diabetes, obesity & metabolism (2023). PMID: 36479786 ↗

    L1bRCTCited in: Pharmacotherapy
  81. [81]

    Gilbert BW, Turpin BB, Murray DS et al.. “The Evaluation of Early Basal Insulin in Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis.” Diabetes/metabolism research and reviews (2026). PMID: 41865288 ↗

    L2aSR_OBSCited in: Pharmacotherapy, Monitoring and Disposition
  82. [82]

    Nguyen B, Quon S, Dhaliwal B et al.. “Early versus late initiation of long-acting insulin in paediatric and adult diabetic ketoacidosis: A systematic review and meta-analysis of randomised control trials.” Diabetes, obesity & metabolism (2026). PMID: 41657118 ↗

    L2aSR_OBSCited in: Pharmacotherapy
  83. [83]

    Shah A, Jamal A, Qadri M et al.. “Early vs. late initiation of long-acting basal insulin during IV insulin in pediatric diabetic ketoacidosis: a GRADE-assessed systematic review and meta-analysis.” European journal of pediatrics (2025). PMID: 41296041 ↗

    L2aSR_OBSCited in: Pharmacotherapy, Special Populations
  84. [84]

    Szabó GV, Szigetváry C, Turan C et al.. “Fluid resuscitation with balanced electrolyte solutions results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults - A systematic review and meta-analysis.” Diabetes/metabolism research and reviews (2024). PMID: 38925619 ↗

    L2aSR_OBSCited in: Pharmacotherapy
  85. [85]

    Li Y, Li H, Dong L et al.. “A Network Meta-Analysis of the Dose-Response Effects of Dapagliflozin on Efficacy and Safety in Adults With Type 1 Diabetes.” Frontiers in endocrinology (2022). PMID: 35872994 ↗

    L2aSR_OBSCited in: Pharmacotherapy
  86. [86]

    Baby N, Wyawahare M, Naik D et al.. “Early use of neutral Protamine Hagedorn (NPH) insulin in the management of diabetic ketoacidosis: an open-label randomized controlled trial in a resource-limited setting.” BMC research notes (2025). PMID: 41199369 ↗

    L1bRCTCited in: Pharmacotherapy
  87. [87]

    Edwards VM, Procter C, Jones AJ et al.. “Adherence to the 2015 and 2020 British Society of Paediatric Endocrinology and Diabetes guidelines and outcomes in critically ill children with diabetic ketoacidosis: a retrospective cohort study.” Archives of disease in childhood (2022). PMID: 35710720 ↗

    L2bCOHORTCited in: Pharmacotherapy
  88. [88]

    Fustiñana AL, Echeveste JR, Pedalino J et al.. “Implementation of a Clinical Practice Guideline for diabetic ketoacidosis at a tertiary pediatric hospital: a before-after study.” Andes pediatrica : revista Chilena de pediatria (2025). PMID: 41842793 ↗

    L1cGUIDELINECited in: Pharmacotherapy, Special Populations
  89. [89]

    Belal MM, Khalefa BB, Rabea EM et al.. “Low dose insulin infusion versus the standard dose in children with diabetic ketoacidosis: a meta-analysis.” Future science OA (2024). PMID: 38827803 ↗

    L2aSR_OBSCited in: Pharmacotherapy
  90. [90]

    Kong YW, Jones HC, Ngan J et al.. “Preventing Diabetic Ketoacidosis with Continuous Ketone Monitoring: Insights from a Clinical Research Case.” Diabetes technology & therapeutics (2026). PMID: 40711834 ↗

    L4CASE_REPORTCited in: Pharmacotherapy, Secondary Assessment
  91. [91]

    Umapathysivam MM, Gunton J, Stranks SN et al.. “Euglycemic Ketoacidosis in Two Patients Without Diabetes After Introduction of Sodium-Glucose Cotransporter 2 Inhibitor for Heart Failure With Reduced Ejection Fraction.” Diabetes care (2024). PMID: 37988720 ↗

    L4CASE_REPORTCited in: Pharmacotherapy
  92. [92]

    Daetwyler E, Zippelius A, Danioth S et al.. “Nivolumab-induced diabetes mellitus-a case report with literature review of the treatment options.” Frontiers in immunology (2023). PMID: 37965350 ↗

    L4CASE_REPORTCited in: Pharmacotherapy
  93. [93]

    Huang Z, Wu Y, Tang C et al.. “A Multicentre, Randomised, Controlled, Open-Label Study of Continuous Subcutaneous Insulin Infusion Plus Henagliflozin for Treating Type 2 Diabetes Mellitus Patients With Severe Hyperglycaemia.” Diabetes, obesity & metabolism (2026). PMID: 41853855 ↗

    L5OTHERCited in: Pharmacotherapy
  94. [94]

    Asiku J, Kalyesubula M, Ross M et al.. “Non-carbohydrate anaplerotic therapy counters empagliflozin-induced diabetic ketosis.” Nutrition & diabetes (2025). PMID: 41145428 ↗

    L5OTHERCited in: Pharmacotherapy
  95. [95]

    Ziegler AG, Cengiz E, Kay TWH. “The future of type 1 diabetes therapy.” Lancet (London, England) (2025). PMID: 40983070 ↗

    L5REVIEW_NARRATIVECited in: Pharmacotherapy
  96. [96]

    Bergmann KR, Abuzzahab MJ, Perepelista V et al.. “Improving Emergency Department Care for Children With Medium- and High-Risk Diabetic Ketoacidosis.” Pediatrics (2025). PMID: 40907982 ↗

    L5OTHERCited in: Pharmacotherapy
  97. [97]

    Blank SP, Blank RM, Laupland KB et al.. “Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation.” Intensive care medicine (2025). PMID: 40493225 ↗

    L5OTHERCited in: Pharmacotherapy
  98. [98]

    Wilmot EG, Beltrand J, Guerci B et al.. “Tubeless automated insulin delivery versus multiple daily injections in children and adults with type 1 diabetes with elevated HbA1c (RADIANT): a multicentre, international, parallel-group, open-label, randomised, controlled trial.” The lancet. Diabetes & endocrinology (2026). PMID: 41747751 ↗

    L1bRCTCited in: Secondary Assessment, Monitoring and Disposition, Special Populations
  99. [99]

    Jendle JH, Garg SK, Thivolet C et al.. “Automated basal insulin delivery versus multiple daily injections in type 1 diabetes: results from a randomized parallel controlled trial.” Frontiers in endocrinology (2025). PMID: 41488135 ↗

    L1bRCTCited in: Secondary Assessment, Special Populations
  100. [100]

    Donovan LE, Lemieux P, Dunlop AD et al.. “Closed-Loop Insulin Delivery in Type 1 Diabetes in Pregnancy: The CIRCUIT Randomized Clinical Trial.” JAMA (2025). PMID: 41134589 ↗

    L1bRCTCited in: Secondary Assessment, Monitoring and Disposition
  101. [101]

    Akturk HK, Perkins BA, Dunn TC. “Clinical Trials in Diabetes: Examining the Value of Use of Continuous Dual Glucose-Ketone Monitoring.” Diabetes technology & therapeutics (2025). PMID: 41267376 ↗

    L2bTRIAL_NONRANDOMCited in: Secondary Assessment
  102. [102]

    An JH, Ko BG, Namkung H et al.. “Differential glycemic effects of DWP16001 in diabetic dogs according to baseline glycemic status: a multicenter randomized controlled trial.” BMC veterinary research (2025). PMID: 40796840 ↗

    L1bRCTCited in: Secondary Assessment
  103. [103]

    Lei M, Zhou Y, Ni Y et al.. “Impact of stepwise diabetes technology advances in older adults with type 1 diabetes: A systematic review and meta-analysis of randomised trials.” Diabetes, obesity & metabolism (2026). PMID: 41388602 ↗

    L2aSR_OBSCited in: Secondary Assessment, Monitoring and Disposition
  104. [104]

    Talaiti M, Liao X, Abulimiti N et al.. “Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta-Analyses.” Journal of diabetes research (2026). PMID: 41958058 ↗

    L2aSR_OBSCited in: Secondary Assessment, Monitoring and Disposition, Prevention
  105. [105]

    Perez Castillo D, Hall L, Senthuran S et al.. “Sodium glucose co-transporter 2 inhibitor-associated euglycaemic diabetic ketoacidosis in the emergency peri-operative period: a systematic review.” Journal of anesthesia (2025). PMID: 40887509 ↗

    L2aSR_OBSCited in: Secondary Assessment
  106. [106]

    Stathi D, Hunt K, Rogers H et al.. “Advanced Hybrid Closed Loop Systems in Pregnancy: A Retrospective Study of Women With Type 1 Diabetes.” Endocrinology, diabetes & metabolism (2026). PMID: 41957663 ↗

    L2bCOHORTCited in: Secondary Assessment, Monitoring and Disposition
  107. [107]

    Hu R, Lu C, Liu Y et al.. “Euglycaemic diabetic ketoacidosis and its risk factors in patients undergoing coronary artery bypass grafting surgery: a single-centre nested case-control study in China.” BMJ open (2025). PMID: 40803742 ↗

    L3bCASE_CONTROLCited in: Secondary Assessment
  108. [108]

    Attia N, Al Noaim K, Mustafa M et al.. “The Use of Dapagliflozin in the Treatment of Children With Severe Insulin Resistance.” Pediatric diabetes (2025). PMID: 41424588 ↗

    L4CASE_REPORTCited in: Secondary Assessment, Special Populations
  109. [109]

    Ma Y, Xue J, Cheng Q et al.. “Immune checkpoint inhibitor-associated diabetes mellitus: the case series report.” Frontiers in endocrinology (2025). PMID: 40687589 ↗

    L4CASE_REPORTCited in: Secondary Assessment
  110. [110]

    Torabi M, Mirzaee M. “Capnography in diabetic ketoacidosis (DKA) diagnosis: a systematic review and meta-analysis.” Revista clinica espanola (2026). PMID: 41765090 ↗

    L2aSR_OBSCited in: Secondary Assessment
  111. [111]

    Abdella Altom SA, Alhajri AHM, Ali HKM et al.. “A Comparative Analysis of Diabetic Ketoacidosis (DKA) in Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) Users Versus Non-users: A Systematic Review.” Cureus (2025). PMID: 41170216 ↗

    L2aSR_OBSCited in: Secondary Assessment
  112. [112]

    Sadeghzadeh S, Li P, Zheng H et al.. “Functional wearable hydrogel microneedle platform for continuous ketone monitoring: Translating from rodents to humans.” Biosensors & bioelectronics (2026). PMID: 41903439 ↗

    L5OTHERCited in: Secondary Assessment
  113. [113]

    Lee AH, Stokes G, Farrell K et al.. “Improving glycaemic outcomes with subsidised access to diabetes technology in a young adult population with type 1 diabetes.” Diabetic medicine : a journal of the British Diabetic Association (2026). PMID: 41841791 ↗

    L5OTHERCited in: Secondary Assessment
  114. [114]

    Akturk HK, Karakus KE, Cengiz D et al.. “Glucose Control and Continuous Glucose Monitoring Metrics During 12 Months of Treatment with Tirzepatide in Overweight or Obese Patients with Type 1 Diabetes.” Diabetes technology & therapeutics (2026). PMID: 41804540 ↗

    L5OTHERCited in: Secondary Assessment
  115. [115]

    Tan RJL, Ahuja A, Shrestha A et al.. “A retrospective observational study evaluating the safety and effectiveness of commercially available automated insulin delivery systems in people with type 1 diabetes and gastroparesis.” Diabetes, obesity & metabolism (2026). PMID: 41713943 ↗

    L5OTHERCited in: Secondary Assessment
  116. [116]

    Takashi N, Omura T, Iijima H et al.. “Evaluation of the impact of a recommended shift in glycaemic management targets for older adults on clinical outcomes and healthcare expenditures in Japan: a protocol for interrupted time-series analysis using a nationwide health insurance claims database.” BMJ open (2026). PMID: 41571422 ↗

    L5OTHERCited in: Secondary Assessment
  117. [117]

    Harsha ML, Ness MA, Marzinke MA. “Clinical utilization of beta-hydroxybutyrate and comparison with urine ketones in a quaternary care health system.” Clinica chimica acta; international journal of clinical chemistry (2026). PMID: 41534642 ↗

    L5OTHERCited in: Secondary Assessment
  118. [118]

    Dhatariya K, Bergenstal RM, Al-Sofiani M et al.. “Continuous ketone monitoring for people with diabetes: international expert recommendations on the application of a new technology.” The lancet. Diabetes & endocrinology (2026). PMID: 41381175 ↗

    L5REVIEW_NARRATIVECited in: Secondary Assessment
  119. [119]

    Zaitoon H, Perl L, Cohen-Sela E et al.. “The virtual Morris water maze for cognitive function assessment in adolescents with type 1 diabetes.” Diabetologia (2026). PMID: 41247493 ↗

    L5OTHERCited in: Secondary Assessment
  120. [120]

    Stephens JW, Dhatariya K, Beamish AJ et al.. “Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group.” Diabetic medicine : a journal of the British Diabetic Association (2026). PMID: 41840846 ↗

    L1cGUIDELINECited in: Monitoring and Disposition, Guidelines and Resources
  121. [121]

    Ólafsdóttir AF, Sveen KA, Wijkman M et al.. “Systematic intensive therapy in addition to continuous glucose monitoring in adults with type 1 diabetes: a multicentre, open-label, randomised controlled trial.” The Lancet regional health. Europe (2025). PMID: 41142656 ↗

    L1bRCTCited in: Monitoring and Disposition
  122. [122]

    Kim JY, Kim S, Kim JH. “Continuous glucose monitoring and risks of acute and chronic diabetes-related complications and mortality in adults with type 1 diabetes: a nationwide cohort study.” Diabetologia (2026). PMID: 41865177 ↗

    L2bCOHORTCited in: Monitoring and Disposition
  123. [123]

    Fatima S, Seto N, Batra K et al.. “Clinical Factors Associated with Failure of Insulin Transition in Adults with Diabetic Ketoacidosis: A Retrospective Cohort Study.” Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (2026). PMID: 41419175 ↗

    L2bCOHORTCited in: Monitoring and Disposition
  124. [124]

    Wu CY, Sharma A, Edwards JD et al.. “Cardiovascular effectiveness and safety of SGLT2 inhibitors vs DPP4 inhibitors by dementia status: a cohort study of older adults with diabetes.” Diabetologia (2026). PMID: 41204979 ↗

    L2bCOHORTCited in: Monitoring and Disposition
  125. [125]

    Li Y, Chen J, Gao Y et al.. “Comparative Safety of SGLT2 Versus DPP4 Inhibitors in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.” Diabetes therapy : research, treatment and education of diabetes and related disorders (2026). PMID: 41678006 ↗

    L1aSR_MA_RCTCited in: Monitoring and Disposition
  126. [126]

    Hu Q, Fan Y, He P. “Islet function impairment outcomes of immune checkpoint inhibitors in cancer patients: a systematic review and meta-analysis.” Frontiers in immunology (2026). PMID: 41939914 ↗

    L2aSR_OBSCited in: Monitoring and Disposition
  127. [127]

    Chiang YC, Dai DF, Chiu YW et al.. “Sodium-Glucose Cotransporter-2 Inhibitors and Acute Kidney Injury Risk: A Systematic Review and Meta-Analysis of Randomized Trials.” Kidney medicine (2026). PMID: 41767694 ↗

    L2aSR_OBSCited in: Monitoring and Disposition
  128. [128]

    Oktavian P, Salma ZN, Harjono S et al.. “Efficacy and Safety of Sodium-Glucose Cotransporter-2 Inhibitors as Add-On Therapy to Insulin Pumps for Type 1 Diabetes: A Systematic Review and Meta-Analysis.” Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (2026). PMID: 41621646 ↗

    L2aSR_OBSCited in: Monitoring and Disposition
  129. [129]

    Balbaa E, Gadelmawla AF, Ibrahim A et al.. “Renal Protection at a Metabolic Cost: A Systematic Review and Meta-Analysis of Perioperative Use of Sodium-Glucose Cotransporter 2 Inhibitors.” Endocrinology, diabetes & metabolism (2026). PMID: 41721639 ↗

    L2aSR_OBSCited in: Monitoring and Disposition
  130. [130]

    Zhang F, Wei L, Liu Y et al.. “Association between the lactate-to-albumin ratio and 28-day all-cause mortality in diabetic ketoacidosis patients: A retrospective cohort study utilizing the MIMIC-IV database.” PloS one (2026). PMID: 41818201 ↗

    L2bCOHORTCited in: Monitoring and Disposition
  131. [131]

    Panic Zaric S, Vukomanovic V, Vukovic R et al.. “Case report: Takotsubo cardiomyopathy and cardiac arrest in a 9-year-old girl with new-onset diabetes presenting with diabetic ketoacidosis: the chicken or the egg?” Frontiers in endocrinology (2025). PMID: 41573196 ↗

    L4CASE_REPORTCited in: Monitoring and Disposition, Special Populations
  132. [132]

    Gandecka-Pempera A, Naskręt D, Adamska A et al.. “Severe euglycemic ketoacidosis following combined therapy with GLP-1 receptor agonist and SGLT-2 inhibitor, refractory to standard treatment: a case report.” Frontiers in endocrinology (2025). PMID: 41127515 ↗

    L4CASE_REPORTCited in: Monitoring and Disposition
  133. [133]

    Sweety S, Panda S, Das RR. “Balanced electrolyte solution vs isotonic saline in the resuscitation of children with diabetic ketoacidosis: A randomized controlled trial.” World journal of clinical pediatrics (2026). PMID: 41884024 ↗

    L1bRCTCited in: Special Populations
  134. [134]

    Gao SY, Huang YG, Wang LB et al.. “Age-related heterogeneity of type 1 diabetes mellitus in children: a single-center retrospective study.” World journal of pediatrics : WJP (2026). PMID: 41455069 ↗

    L2bCOHORTCited in: Special Populations
  135. [135]

    Rivetti G, Braile M, Di Sessa A et al.. “Acute Kidney Injury in Children with Polyuria: A Systematic Review.” Journal of clinical medicine (2026). PMID: 41517599 ↗

    L2aSR_OBSCited in: Special Populations
  136. [136]

    Idrees H, Memon F, Alam R et al.. “Systematic Review and Meta-Analysis of Insulin Dose and Route of Administration Regimens for Diabetic Ketoacidosis in Children and Adolescents.” Journal of clinical medicine (2025). PMID: 41227190 ↗

    L2aSR_OBSCited in: Special Populations
  137. [137]

    Pachapure S, Kandagal J, Revanasiddappa M et al.. “Acute Kidney Injury in Children with Type 1 Diabetes Mellitus Hospitalized for Diabetic Ketoacidosis: A Retrospective Study.” Journal of the ASEAN Federation of Endocrine Societies (2025). PMID: 41357044 ↗

    L2bCOHORTCited in: Special Populations
  138. [138]

    Günbaş M, Büyükkaya Besen D, Dervişoğlu M. “The effect of one-year online counseling provided to mothers of children and adolescents with newly diagnosed type 1 diabetes on A1C and patient outcomes: A retrospective study.” Journal of pediatric nursing (2026). PMID: 41455371 ↗

    L2bCOHORTCited in: Special Populations
  139. [139]

    Zhao S, Liu X, Tan P et al.. “Case report: Immune checkpoint inhibitor-induced fulminant diabetic ketoacidosis: a case-based review and considerations for immunotherapy discontinuation.” Frontiers in immunology (2025). PMID: 41635837 ↗

    L4CASE_REPORTCited in: Special Populations
  140. [140]

    Calderon Martinez E, Saji SZ, Sámano Sánchez M et al.. “Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections for Glycemic Control in Pediatric Patients With Type 1 Diabetes Mellitus: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.” AACE endocrinology and diabetes (2026). PMID: 41938301 ↗

    L2aSR_OBSCited in: Special Populations
  141. [141]

    Ali NM, Alhag MH, Mustafa AE et al.. “Prevalence, Clinical Profile, and Outcomes of Diabetic Ketoacidosis (DKA) in Pediatric ICU Patients in the Middle East: A Systematic Review and Meta-Analysis.” Cureus (2026). PMID: 41859577 ↗

    L2aSR_OBSCited in: Special Populations
  142. [142]

    Natale P, Green SC, Tunnicliffe DJ et al.. “Dipeptidyl peptidase 4 (DPP-4) inhibitors for people with chronic kidney disease and diabetes.” The Cochrane database of systematic reviews (2025). PMID: 41263251 ↗

    L2aSR_OBSCited in: Special Populations
  143. [143]

    Omar Salem Kanzwl SM, Alhajri AHM, Abdelbagi Mohammed YJ et al.. “A Comparative Effectiveness of Intravenous Fluids and Insulin Regimens in the Acute Management of Diabetic Ketoacidosis (DKA) and Hypoglycemia: A Systematic Review.” Cureus (2025). PMID: 41262789 ↗

    L2aSR_OBSCited in: Special Populations
  144. [144]

    Convertino I, Lucenteforte E, Monzillo J et al.. “SodiuM glucose cotrANsporter-2 (SGLT-2) inhibitors in the treatment of type II DiAbetes in Tuscany: utiLizatiOn patteRns, and relatEd clinical use evaluation; the MANDALORE study protocol.” Frontiers in endocrinology (2026). PMID: 41948551 ↗

    L5OTHERCited in: Special Populations
  145. [145]

    Ruprai B, Catania S, Berati V et al.. “Efficacy and Management of Automated Insulin Delivery Systems Perioperatively in Type 1 Diabetes - A Scoping Review.” Canadian journal of diabetes (2026). PMID: 41825832 ↗

    L5REVIEW_NARRATIVECited in: Special Populations
  146. [146]

    Hussain S, Tree T, Mathieu C et al.. “An international consensus on screening and monitoring early-stage type 1 diabetes: A roadmap to European implementation.” Diabetes, obesity & metabolism (2026). PMID: 41821267 ↗

    L5REVIEW_NARRATIVECited in: Special Populations
  147. [147]

    Lechsner P, Holl RW, Steger F. “Screening for diabetes mellitus type 1 in the pediatric general population: an ethical analysis.” European journal of pediatrics (2026). PMID: 41820768 ↗

    L5REVIEW_NARRATIVECited in: Special Populations, Prevention
  148. [148]

    Chaffin Z, Ghetti S, Tancredi D et al.. “Inflammatory profile of diabetic ketoacidosis in children with type 1 diabetes.” BMJ open diabetes research & care (2026). PMID: 41807017 ↗

    L5OTHERCited in: Special Populations
  149. [149]

    Ward MC, Boucsein A, Zhou Y et al.. “Extended Use of Automated Insulin Delivery in Young People with Type 1 Diabetes and Elevated HbA1c: 52-Week Outcomes of the CO-PILOT Trial.” Diabetes technology & therapeutics (2026). PMID: 41784095 ↗

    L5OTHERCited in: Special Populations
  150. [150]

    Mustafa OG, Haq M, Dashora U et al.. “Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group.” Diabetic medicine : a journal of the British Diabetic Association (2023). PMID: 36370077 ↗

    L1cGUIDELINECited in: Prevention
  151. [151]

    Sharma A, Ali Baig S, Thayakaran R et al.. “Clinical characteristics and outcomes of diabetes-related ketoacidosis (DKA) in sodium-glucose co-transporter-2 inhibitor (SGLT2i) users with type 2 diabetes.” Diabetes, obesity & metabolism (2025). PMID: 40919651 ↗

    L2aSR_OBSCited in: Prevention
  152. [152]

    Beccia C, McMorrow R, Donald A et al.. “Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful in preventing acute complications? A systematic review.” BMJ open (2024). PMID: 39353690 ↗

    L2aSR_OBSCited in: Prevention
  153. [153]

    Minerba E, Maines E, Quaglia N et al.. “Diabetes Awareness Campaigns to Prevent Ketoacidosis at the Diagnosis of Type 1 Diabetes: Efficacy on Multiple Outcomes and Predictors of Success: A Systematic Review.” Journal of personalized medicine (2024). PMID: 39728028 ↗

    L2aSR_OBSCited in: Prevention
  154. [154]

    Alshehri NA, Alessa MS, Alrasheed AA et al.. “Role of Continuous Glucose Monitoring in Supporting Glycemic Control Among Adolescents with Type 1 Diabetes in Saudi Arabia: A Retrospective Study.” Healthcare (Basel, Switzerland) (2025). PMID: 40077058 ↗

    L2bCOHORTCited in: Prevention
  155. [155]

    Takemura M, Ikemura K, Okuda M. “Factors and preventive strategies for perioperative euglycemic diabetic ketoacidosis in patients with type 2 diabetes receiving sodium-glucose cotransporter 2 inhibitors: a retrospective study.” Journal of pharmaceutical health care and sciences (2025). PMID: 40855351 ↗

    L2bCOHORTCited in: Prevention
  156. [156]

    Barth KE, Spottiswoode N, Hurabielle C et al.. “Clinical and biological heterogeneity of multisystem inflammatory syndrome in adults following SARS-CoV-2 infection: a case series.” Frontiers in medicine (2023). PMID: 37484839 ↗

    L4CASE_REPORTCited in: Prevention
  157. [157]

    Haile HK, Fenta TG. “Magnitude, risk factors and economic impacts of diabetic emergencies in developing countries: A systematic review.” PloS one (2025). PMID: 39903717 ↗

    L2aSR_OBSCited in: Prevention
  158. [158]

    Feleke SF, Dessie AM, Getachew ZD et al.. “Burden of diabetic ketoacidosis and its predictors among diabetic patients in Ethiopia: Systematic review and meta-analysis.” PloS one (2025). PMID: 39847589 ↗

    L2aSR_OBSCited in: Prevention
  159. [159]

    Ahmed AAO, Mounfali MAA, Yassin T et al.. “Prevalence and patterns of diabetic ketoacidosis (DKA) among diabetic patients presenting to hospitals in northern state, Sudan: a cross-sectional study during the 2025 humanitarian crisis.” BMC endocrine disorders (2025). PMID: 41299380 ↗

    L5OTHERCited in: Prevention
  160. [160]

    Sinatra N, Cuttone G, Geraci G et al.. “Correlation Between Hypophosphatemia and Hyperventilation in Critically Ill Patients: Causes, Clinical Manifestations, and Management Strategies.” Biomedicines (2025). PMID: 41153669 ↗

    L5REVIEW_NARRATIVECited in: Prevention
  161. [161]

    Saygili M, Gollu G, Tekin Z. “Pandemic-driven healthcare disruptions and their disproportionate impact on patients with diabetes: evidence from Texas.” Frontiers in public health (2025). PMID: 41112649 ↗

    L5OTHERCited in: Prevention
  162. [162]

    Tian B, Cao X, Cheng J et al.. “Aspiration pneumonia in diabetic ketoacidosis: a decade-long analysis of occurrence , associated risk factors and clinical outcomes in 530,700 US hospitalizations.” Diabetology & metabolic syndrome (2025). PMID: 41094594 ↗

    L5OTHERCited in: Prevention
  163. [163]

    Wondie Y, Minwuyelet A, Bogale AD et al.. “Risk factors of diabetic ketoacidosis among patients with diabetes attending at public hospitals of East Gojjam Zone, Northwest Ethiopia: an unmatched case - control study.” BMC endocrine disorders (2025). PMID: 41039479 ↗

    L5OTHERCited in: Prevention
  164. [164]

    Templeman EL, Ferrat LA, Parikh HM et al.. “Development and recalibration of a multivariable type 1 diabetes prediction model for type 1 diabetes across multiple screening studies.” BMC medicine (2025). PMID: 40691800 ↗

    L5OTHERCited in: Prevention
  165. [165]

    Zhang B, Deng L. “Application of SGLT-2 inhibitors in non-diabetic CKD: mechanisms, efficacy, and safety.” Frontiers in medicine (2025). PMID: 40665981 ↗

    L5REVIEW_NARRATIVECited in: Prevention
  166. [166]

    Rewers M. “Health economic considerations of screening for early type 1 diabetes.” Diabetes, obesity & metabolism (2025). PMID: 40555704 ↗

    L5REVIEW_NARRATIVECited in: Prevention
  167. [167]

    Bell KJ, Lain SJ. “The Changing Epidemiology of Type 1 Diabetes: A Global Perspective.” Diabetes, obesity & metabolism (2025). PMID: 40536127 ↗

    L5REVIEW_NARRATIVECited in: Prevention
  168. [168]

    Besser REJ, Campbell F, Damazer K et al.. “UK best practice recommendations for children and young people <18 years with pre-stage 3 type 1 diabetes, on behalf of the British Society for Paediatric Endocrinology and Diabetes (BSPED).” Diabetic medicine : a journal of the British Diabetic Association (2025). PMID: 40988096 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  169. [169]

    Phillip M, Achenbach P, Addala A et al.. “Consensus Guidance for Monitoring Individuals With Islet Autoantibody-Positive Pre-Stage 3 Type 1 Diabetes.” Diabetes care (2024). PMID: 38912694 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  170. [170]

    Phillip M, Achenbach P, Addala A et al.. “Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes.” Diabetologia (2024). PMID: 38910151 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  171. [171]

    Dhatariya KK. “The management of diabetic ketoacidosis in adults-An updated guideline from the Joint British Diabetes Society for Inpatient Care.” Diabetic medicine : a journal of the British Diabetic Association (2022). PMID: 35224769 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  172. [172]

    Priyambada L, Wolfsdorf JI, Brink SJ et al.. “ISPAD Clinical Practice Consensus Guideline: Diabetic ketoacidosis in the time of COVID-19 and resource-limited settings-role of subcutaneous insulin.” Pediatric diabetes (2020). PMID: 32935435 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  173. [173]

    . “ACOG Practice Bulletin No. 201: Pregestational Diabetes Mellitus.” Obstetrics and gynecology (2018). PMID: 30461693 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  174. [174]

    Price HC, Ismail K. “Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings.” Diabetic medicine : a journal of the British Diabetic Association (2018). PMID: 30152583 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  175. [175]

    Scott AR. “Management of hyperosmolar hyperglycaemic state in adults with diabetes.” Diabetic medicine : a journal of the British Diabetic Association (2015). PMID: 25980647 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  176. [176]

    Bismuth E, Bouche C, Caliman C et al.. “Management of pregnancy in women with type 1 diabetes mellitus: guidelines of the French-Speaking Diabetes Society (Société francophone du diabète [SFD]).” Diabetes & metabolism (2012). PMID: 22521040 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  177. [177]

    Savage MW, Dhatariya KK, Kilvert A et al.. “Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis.” Diabetic medicine : a journal of the British Diabetic Association (2011). PMID: 21255074 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  178. [178]

    Arima H, Iwama S, Inaba H et al.. “Management of immune-related adverse events in endocrine organs induced by immune checkpoint inhibitors: clinical guidelines of the Japan Endocrine Society.” Endocrine journal (2019). PMID: 31243183 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  179. [179]

    VanBaak KD, Nally LM, Finigan RT et al.. “Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management.” Wilderness & environmental medicine (2019). PMID: 31753543 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  180. [180]

    Taylor S, Cannon M, Church D et al.. “iCatCare 2025 consensus guidelines on the diagnosis and management of diabetes mellitus in cats.” Journal of feline medicine and surgery (2025). PMID: 41224734 ↗

    L1cGUIDELINECited in: Guidelines and Resources

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