Morbidity and mortality of diabetic ketoacidosis with and without insulin pump care

Diabetes Technol Ther. 2012 Dec;14(12):1149-54. doi: 10.1089/dia.2012.0161. Epub 2012 Sep 25.


Diabetic ketoacidosis (DKA) is one of the most common, costly, and dangerous acute complications in people with type 1 diabetes (T1D). Although DKA has been reported to occur with less frequency than severe hypoglycemia, it is associated with a higher mortality rate and is the leading cause of diabetes-related deaths in children and adolescents. The most common risk factor for DKA is lack of adherence to insulin treatment. Other factors include underinsurance, psychiatric disorders, occlusion of insulin pump infusion sets, and illness. It has been suggested that use of continuous subcutaneous insulin infusion therapy may increase the risk for DKA, although clinical trials have not supported this claim. Expert care within a T1D specialty clinic may help reduce the risk of DKA mortality. Further advances are needed in developing new technologies and methods to improve glycemic control in intensively treated patients without increasing the risk of acute complications. The purpose of this review is to discuss DKA morbidity and mortality in youth with T1D, particularly in relation to insulin pump use.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Blood Glucose / drug effects*
  • Blood Glucose / metabolism
  • Blood Glucose Self-Monitoring
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / mortality*
  • Diabetic Ketoacidosis / blood
  • Diabetic Ketoacidosis / drug therapy
  • Diabetic Ketoacidosis / mortality*
  • Female
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Infant
  • Insulin / administration & dosage*
  • Insulin Infusion Systems / adverse effects*
  • Insurance, Health
  • Male
  • Medication Adherence
  • Monitoring, Ambulatory
  • Morbidity
  • Risk Factors


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin