{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:13:28Z","timestamp":1784888008437,"version":"3.55.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100013528","name":"Diabetes Canada","doi-asserted-by":"publisher","award":["OG-3-21-5572-BP"],"award-info":[{"award-number":["OG-3-21-5572-BP"]}],"id":[{"id":"10.13039\/100013528","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>We aimed to determine whether diabetes complications, such as kidney disease that may impair acid-base buffering capacity, independently predict the risk of subsequent diabetic ketoacidosis (DKA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We accessed previously collected 34-year data from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study through public data access. Multivariable Cox proportional hazards models with time-varying exposures and covariates were used to examine the associations of macrovascular disease and early and late stages of neuropathy, nephropathy, and retinopathy, with subsequent DKA occurrence as the outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of 1,441 participants, 297 experienced 488 DKA events over follow-up. Major adverse cardiovascular events [hazard ratio (HR) 3.16, 95% CI 1.57\u20136.35, P = 0.001] and late-stage neuropathy, which comprised serious foot ulcer or amputation (HR 1.59, 95% CI 1.04\u20132.45, P = 0.03) were independently associated with higher DKA risk. Higher risk was also associated with shorter diabetes duration (HR 0.76, 95% CI 0.64\u20130.91, P = 0.002), female sex (HR 2.04, 95% CI 1.56\u20132.67, P &amp;lt; 0.001), current insulin pump use (HR 3.04, 95% CI 2.29\u20134.02, P &amp;lt; 0.001), higher time-updated HbA1c (per additional 1%: HR 1.39, 95% CI 1.29\u20131.50, P &amp;lt; 0.001), and higher current insulin dose (per 1 additional unit\/kg\/day: HR 2.32, 95% CI 1.62\u20133.33, P &amp;lt; 0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>A major cardiovascular event, foot ulcer, or amputation confers the greatest risk of future DKA independent of previously recognized risk factors, implying a need to target patients with these events for DKA prevention interventions, such as self-management skills for metabolic control, management of depression, and DKA education.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc24-2385","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T15:21:17Z","timestamp":1739546477000},"page":"614-622","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":8,"title":["Longitudinal Determination of Diabetes Complications and Other Clinical Variables as Risk Factors for Diabetic Ketoacidosis in Type 1 Diabetes"],"prefix":"10.2337","volume":"48","author":[{"given":"Priya","family":"Bapat","sequence":"first","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"2Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton R.","family":"Budhram","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, 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Ontario, Canada"},{"name":"5Internal Medicine and Critical Care Department, King Abdullah bin Abdulaziz University Hospital, Princess Norah University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha J.","family":"Verhoeff","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"6Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug","family":"Mumford","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"7Patient-partner"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajeeha","family":"Cheema","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanna","family":"Weisman","sequence":"additional","affiliation":[{"name":"1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"2Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"11Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"11Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"12Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"13Department of Medicine, University Health Network and Sinai Health, University of Toronto, Toronto, Ontario, 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