{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T13:01:42Z","timestamp":1785157302617,"version":"3.55.0"},"reference-count":145,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Diabetic ketoacidosis (DKA) remains a preventable yet frequent complication at the onset of type 1 diabetes (T1D) in children, driven by delayed symptom recognition, socioeconomic disparities, and inconsistent access to care. Early identification of presymptomatic T1D through autoantibody-based screening, together with emerging disease-modifying therapies, may reduce the incidence of DKA. This review synthesizes evidence on epidemiology, risk determinants, screening strategies, and immunological interventions relevant to DKA prevention. Methods: A narrative review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar (2011\u20132026). Eligible sources included clinical studies, guidelines, systematic reviews, meta-analyses, and prevention trials addressing staging, screening, epidemiology, and disease-modifying treatments in pediatric T1D. Landmark publications outside this timeframe were included when essential. Evidence was integrated to identify determinants of DKA and strategies to reduce its occurrence. Results: DKA risk is influenced by younger age, socioeconomic disadvantage, rural residence, misdiagnosis, and limited access to specialized care. Sustained public awareness and community-based education reduce DKA incidence, whereas short-term campaigns show transient effects. Structured screening programs, including TrialNet and TEDDY, demonstrate near-elimination of DKA among monitored children. Teplizumab delayed progression from stage 2 to stage 3 T1D by a median of approximately 24 months in the original TN-10 trial, with extended follow-up demonstrating a median delay of 32.5 months. It is approved for individuals with stage 2 T1D aged \u2265 1 year and has recently gained approval for selected patients with newly diagnosed T1D, expanding opportunities for early disease modification. Global networks such as INNODIA strengthen prevention through coordinated biomarker-driven research. Conclusions: Reducing DKA at T1D onset requires integrated, sustained strategies combining public awareness, systematic autoantibody screening, structured follow-up, and access to emerging immunotherapies. Coordinated care across primary providers, pediatric endocrinologists, and research networks is essential to advance a proactive, prevention-oriented model of pediatric T1D care.<\/jats:p>","DOI":"10.3390\/jcm15155865","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:54:26Z","timestamp":1785153266000},"page":"5865","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reducing Diabetic Ketoacidosis in Pediatric Type 1 Diabetes: The Impact of Screening Programs and Early Disease-Modifying Treatment"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3487-0664","authenticated-orcid":false,"given":"Yung-Yi","family":"Lan","sequence":"first","affiliation":[{"name":"Center for Medical Education in English, Poznan University of Medical Sciences, 41 Jackowskiego St., 60-512 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3314-7422","authenticated-orcid":false,"given":"Rujith","family":"Kovinthapillai","sequence":"additional","affiliation":[{"name":"Center for Medical Education in English, Poznan University of Medical Sciences, 41 Jackowskiego St., 60-512 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"K\u0119dzia","sequence":"additional","affiliation":[{"name":"Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, ul. Szpitalna 27\/33, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3245-8131","authenticated-orcid":false,"given":"El\u017cbieta","family":"Niechcia\u0142","sequence":"additional","affiliation":[{"name":"Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, ul. Szpitalna 27\/33, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/pedi.13406","article-title":"ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"23","author":"Glaser","year":"2022","journal-title":"Pediatr. 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