Real‐World Burden of Diabetic Ketoacidosis in Type 1 Diabetes in the French SFDT1 Cohort: The SFDT1 ‐ DKA Study

ABSTRACT Aims Diabetic ketoacidosis (DKA) is a major acute complication of Type 1 diabetes (T1D). The SFDT1‐DKA study aims to describe the real‐world burden, sociodemographic, and clinical characteristics associated with DKA for people with T1D in France. Methods This retrospective study included participants from the French SFDT1 prospective cohort. The index date corresponded to the most‐recent SFDT1 visit, between January 1st 2023 and December 31st 2024. Sociodemographic and clinical data were collected, along with DKA and severe hypoglycemic episodes (SHE) in the 12 months prior to the index date. Results We included 2685 participants, 51.4% male, mean age 36.8 years, mean age at diagnosis 16.1 years, mean T1D duration 20.7 years. The proportion of participants with ≥ 1 DKA events in the 12 months prior to the index date was 4.5% [95% CI 3.8%; 5.4%] and associated with younger age ( p < 0.001), younger age at T1D diagnosis ( p = 0.015), shorter T1D duration (< 0.001) and higher HbA1c ( p = 0.001). DKA rates were highest in 18–24 year olds (10.3% [95% CI 7.5%; 13.7%] of this age group). Automated insulin delivery (AID) was associated with reduced DKA compared to open‐loop systems (3.1% vs. 5.4%, p = 0.034). CGM users had lower DKA rates versus self‐monitoring of blood glucose (SMBG) (4.3% vs. 8.1%, p = 0.034). Participants with ≥ 1 DKA events in the previous 12 months had increased SHEs (27.0% vs. 8.5%, p < 0.001). Conclusions DKA is a significant acute complication for people with T1D in France, even on AID. Our study identified people with T1D for whom education on ketone monitoring and prevention of DKA and SHE is emphasised.