Global healthcare company Abbott released real-world data that reveals a rising global burden of diabetic ketoacidosis among people with diabetes.
The findings, presented at the 19th International Conference on Advanced Technologies & Treatments for Diabetes in Barcelona, Spain, highlighted gaps in ketone monitoring by patients and healthcare providers.
Diabetic ketoacidosis, or DKA, happens when ketones accumulate to dangerous levels in the blood, often before symptoms appear, leading to serious health risks. It ranks as a leading cause of death for people under 58 with Type 1 diabetes and increasingly affects those with Type 2 diabetes.
“DKA most frequently results from not having enough insulin in the blood – either because of new diagnosis of diabetes, missed insulin injections, or insulin pump failures. People with diabetes can also develop DKA during illnesses like viral or bacterial infections,” according to UC Davis Health.
“Early signs of DKA include excessive thirst, frequent urination, nausea, abdominal pain, weakness and confusion. … Signs of DKA that suggest a medical emergency needing immediate treatment include vomiting … trouble breathing, and confusion or lethargy,” per UC Davis.
A 23-year UK study of nearly 660,000 people with diabetes showed DKA rates more than tripling in adults with Type 1 diabetes and rising sixfold in those with Type 2 diabetes. Recurrence affected 31.5% of Type 1 patients and 12.1% of Type 2 patients after one episode, hitting younger adults, women, and those in deprived areas hardest.
“This long-term analysis shows that DKA is not only becoming more common, but also more likely to reoccur, and often in the same individuals,” said Pratik Choudhary, M.D., endocrinologist at Leicester Diabetes Centre & University of Leicester and an author of the study.
“DKA can develop quickly and display vague early signs, which is why so many people experience repeat episodes. These findings challenge assumptions about who is at risk and highlight the urgent need for earlier identification of rising ketones before DKA develops,” Abbott reported in a press release.
A French survey of 553 adults with Type 1 diabetes found 95% aware of ketosis and 91% of DKA, with over half having prior episodes, yet 38% never tested ketones. Barriers included recognizing symptoms and time demands, even among users of continuous glucose monitors and automated insulin delivery systems. Clinicians are less often reminded that those on multiple daily insulin injections should test ketones.
U.S. interviews with endocrinologists, pediatric endocrinologists, and primary care physicians exposed inconsistent ketone monitoring practices, limited routine use of ketone data, and varying advice on responses to rising levels.
Providers noted absent standardized guidance, missing records, and overreliance on glucose trends, which do not mirror ketone status.
“These studies show a troubling reality: people are still missing the early rise in ketones that can quickly turn into diabetic ketoacidosis,” said Mahmood Kazemi, M.D., chief medical officer for Abbott’s diabetes care business. “DKA can escalate in a matter of hours, often before symptoms are recognized, and today’s testing methods simply aren’t used consistently enough to catch it. This growing burden underscores the need for clearer clinical guidance and more accessible ways for people to see rising ketones sooner.”
An international expert paper, supported by Breakthrough T1D, stresses continuous ketone monitoring to reduce DKA risk, as glucose readings often lag behind ketone buildup.
The data point to the need for better early detection tools beyond infrequent blood or urine strips.