Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;26(3):198-202.
doi: 10.1089/dia.2023.0307.

Diabetic Ketoacidosis at Onset of Type 1 Diabetes and Glycemic Outcomes with Closed-Loop Insulin Delivery

Rama Lakshman  1 , Mazin Najami  1 , Janet M Allen  1   2 , Julia Ware  1   2 , Malgorzata E Wilinska  1   2 , Sara Hartnell  3 , Ajay Thankamony  2 , Tabitha Randell  4 , Atrayee Ghatak  5 , Rachel E J Besser  6   7 , Daniela Elleri  8 , Nicola Trevelyan  9 , Fiona M Campbell  10 , Roman Hovorka  1   2 , Charlotte K Boughton  1   3
Affiliations

Diabetic Ketoacidosis at Onset of Type 1 Diabetes and Glycemic Outcomes with Closed-Loop Insulin Delivery

Rama Lakshman et al. Diabetes Technol Ther. 2024 Mar.

Abstract

The presence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) is associated with higher glycated hemoglobin levels over time. We evaluated whether hybrid-closed loop (HCL) therapy from onset of T1D could prevent the adverse impact of DKA at diagnosis on long-term glycemic outcomes. This was a posthoc analysis from 51 adolescents using HCL from diagnosis of T1D as part of the CLOuD trial (NCT02871089). We compared glycemic and insulin metrics between adolescents with (n = 17) and without (n = 34) DKA at diagnosis. Participants with and without DKA at diagnosis had similar time in target glucose range 3.9-10.0 mmol/L (70-180 mg/dL), time below range (<3.9 mmol/L, <70 mg/dL) and HbA1c at 6, 12, and 24 months. While insulin requirements at 6 months were higher in those with DKA at diagnosis, this was not statistically significant after adjusting for bodyweight. Residual C-peptide secretion was similar between groups. We conclude that HCL therapy may mitigate against the negative glycemic effects of DKA at T1D diagnosis.

Keywords: Artificial pancreas; Closed-loop systems; Diabetic ketoacidosis; Type 1 diabetes.

PubMed Disclaimer

Conflict of interest statement

C.K.B. has received consulting fees from CamDiab and speaker honoraria from Ypsomed. J.W. reports receiving speaker honoraria from Ypsomed. M.E.W. reports patents related to closed-loop and being a consultant at CamDiab. S.H. serves as a member of Medtronic advisory board, is a director of Ask Diabetes Ltd providing training and research support in health care settings, and reports having received training honoraria from Medtronic and Sanofi and consulting fees for CamDiab. T.R. receives consultancy fees from Abbott Diabetes care and has received honoraria from NovoNordisk for delivering educational meetings. R.E.J.B. reports receiving speaker honoraria from Eli Lilly and Springer Healthcare, and reports sitting on the NovoNordisk UK Foundation Research Selection Committee on a voluntary basis. R.H. reports receiving speaker honoraria from Eli Lilly, Dexcom, and Novo Nordisk, receiving license and/or consultancy fees from BBraun and Abbott Diabetes Care; patents related to closed-loop, and being director at CamDiab. M.N., R.L., J.M.A., A.T., A.G., D.E., N.T., and F.M.C. declare no competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Glycemic and insulin data for first 24 months from diagnosis of T1D. (A) The percentage time in range 3.9–10.0 mmol/L (70–180 mg/dL) (mean ± SD) of sensor glucose levels from 2 to 24 months after diagnosis of T1D. (B) The percentage time in hypoglycemia <3.9 mmol/L (<70 mg/dL) (median, IQR) from 2 to 24 months after diagnosis. (C) The HbA1c level (mean ± SD) at baseline and at 6, 12, and 24 months after diagnosis. (D) The total daily insulin dose (median, IQR) from 2 to 24 months after diagnosis of T1D. (E) The AUC for the plasma C-peptide level in response to a mixed-meal tolerance test (median, IQR) at baseline and at 6, 12, and 24 months after diagnosis. AUC, area under the curve; HbA1c, glycated hemoglobin; IQR, interquartile range; SD, standard deviation; T1D, type 1 diabetes.
See this image and copyright information in PMC

References

    1. National Paediatrics Diabets Audit, Annual report 2020–21: Care processes and outcomes. 2021. Available from: https://www.rcpch.ac.uk/resources/npda-annual-reports#downloadBox [Last accessed: April 25, 2023].
    1. Rewers A, Dong F, Slover RH, et al. . Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado youth, 1998–2012. JAMA 2015;313:1570–1572; doi: 10.1001/jama.2015.1414 - DOI - PubMed
    1. Duca LM, Reboussin BA, Pihoker C, et al. . Diabetic ketoacidosis at diagnosis of type 1 diabetes and glycemic control over time: The SEARCH for diabetes in youth study. Pediatric Diabetes 2019;20:172–179; doi: 10.1111/pedi.12809 - DOI - PMC - PubMed
    1. Duca LM, Wang B, Rewers M, et al. . Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care 2017;40:1249–1255. 20170630; doi: 10.2337/dc17-0558 - DOI - PubMed
    1. Fredheim S, Johannesen J, Johansen A, et al. . Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels. Diabetologia 2013;56:995–1003. 20130207; doi: 10.1007/s00125-013-2850-z - DOI - PubMed

LinkOut - more resources