Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes

Lancet Diabetes Endocrinol. 2020 May;8(5):436-446. doi: 10.1016/S2213-8587(20)30042-5.


Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes, which is receiving more attention given the increased DKA risk associated with SGLT inhibitors. Sociodemographic and modifiable risk factors were identified with strong evidence for an increased risk of DKA, including socioeconomic disadvantage, adolescent age (13-25 years), female sex, high HbA1c, previous DKA, and psychiatric comorbidities (eg, eating disorders and depression). Possible prevention strategies, which include the identification of people at risk based on non-modifiable sociodemographic risk factors, are proposed. As a second risk mitigation strategy, structured diabetes self-management education that addresses modifiable risk factors can be used. Evidence has found that structured education leads to reduced DKA rates. Knowledge of these risk factors and potent risk mitigation strategies are important to identify subgroups of people with an elevated DKA risk. This knowledge should also be used when adjunct therapy options with an increased DKA risk are considered. Prevention of DKA in people with type 1 diabetes is an important clinical task, which should also be addressed when SGLT inhibitors are part of therapy.

Publication types

  • Review

MeSH terms

  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetic Ketoacidosis / etiology*
  • Diabetic Ketoacidosis / prevention & control
  • Female
  • Humans
  • Male
  • Risk Factors
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use


  • Sodium-Glucose Transporter 2 Inhibitors