{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T19:27:57Z","timestamp":1787254077225,"version":"build-2736575974"},"reference-count":20,"publisher":"American Diabetes Association","issue":"9","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To investigate whether detectable C-peptide levels in type 1 diabetes is associated with a lower risk of diabetic ketoacidosis (DKA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We analyzed the Diabetes Control and Complications Trial publicly available data repository for the association between detectable stimulated C-peptide (&amp;gt;0.2 nmol\/mL, measured annually) and DKA incidence over an average 6.5-year follow-up. We used crude and adjusted Andersen-Gill models for recurrent DKA events with time-dependent covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of the 1,441 participants (53% male, median age 27 years), 129 (9%) experienced 180 DKA events. Of these events, 179 (99.44%) occurred after C-peptide was \u22640.2 nmol\/L in the prior year and only 1 event occurred with C-peptide &amp;gt;0.2 nmol\/L. C-peptide &amp;gt;0.2 nmol\/L was associated with a DKA hazard ratio of 0.07 (95% CI 0.01\u20130.48; P = 0.007), consistent across adjusted models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Endogenous insulin production was significantly associated with lower DKA risk, suggesting that treatments preserving insulin production could decrease long-term DKA risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0220","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:54:32Z","timestamp":1783605272000},"page":"1585-1588","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Detectable C-Peptide and Diabetic Ketoacidosis Risk in Type 1 Diabetes"],"prefix":"10.2337","volume":"49","author":[{"given":"Mohammad I.","family":"Abuabat","sequence":"first","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of Endocrinology, Department of Medicine, University of Toronto 2 , Toronto, Ontario, Canada"},{"name":"Internal Medicine and Critical Care Department, King Abdullah bin Abdulaziz University Hospital, Princess Norah University 3 , Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton","family":"Budhram","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of General Internal Medicine, Department of Medicine, University Health Network and Sinai Health, University of Toronto 4 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Bapat","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Toronto 2 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmohsen","family":"Bakhsh","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of Endocrinology, Department of Medicine, University of Toronto 2 , Toronto, Ontario, Canada"},{"name":"Kidney and Pancreas Health Centre, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre 5 , Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1644-1532","authenticated-orcid":false,"given":"Yucheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of General Internal Medicine, Department of Medicine, University Health Network and Sinai Health, University of Toronto 4 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajeeha","family":"Cheema","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Patient-partner (person with lived type 1 diabetes experience) 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha J.","family":"Verhoeff","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Temerty Faculty of Medicine, University of Toronto 7 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug","family":"Mumford","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Patient-partner (person with lived type 1 diabetes experience) 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrej","family":"Orszag","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of Endocrinology, Department of Medicine, University of Toronto 2 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fralick","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of General Internal Medicine, Department of Medicine, University Health Network and Sinai Health, University of Toronto 4 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanna","family":"Weisman","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of Endocrinology, Department of Medicine, University of Toronto 2 , Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management, and Evaluation, University of Toronto 8 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leif Erik","family":"Lovblom","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management, and Evaluation, University of Toronto 8 , Toronto, Ontario, Canada"},{"name":"Biostatistics Department, University Health Network 9 , Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5885-0046","authenticated-orcid":false,"given":"Bruce A.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 1 , Toronto, Ontario, Canada"},{"name":"Division of Endocrinology, Department of Medicine, University of Toronto 2 , Toronto, Ontario, Canada"},{"name":"Institute of 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