Ketoacidosis at childhood type 1 diabetes onset negatively affects residual beta-cell functions during the first year after diagnosis

This study investigates whether pediatric patients presenting with diabetic ketoacidosis (DKA) at the time of type 1 diabetes (T1D) diagnosis experience increased insulin requirements, reduced rates of partial remission, and diminished C-peptide secretion over the first year post-diagnosis, relative to children without DKA. The study included 101 children with newly diagnosed T1D. DKA was classified based on the International Society of Pediatric Diabetes (ISPAD) guidelines, and participants were categorized by DKA occurrence and followed for one year post-diagnosis. HbA1c, insulin requirements, and stimulated C-peptide in a mixed meal tolerance test were assessed within 14 days of diagnosis and 6 and 12 months after diagnosis. Our results showed that DKA at T1D negatively affects residual beta-cell function during the year after diagnosis. The DKA cohort had higher insulin requirements across all study visits; however, the occurrence of partial remission did not differ significantly between study groups. Children with DKA at T1D diagnosis exhibit a significant reduction in stimulated C-peptide by 6 months post-diagnosis (AUC: DKA: 0.54 nmol/L vs. non-DKA: 0.68 nmol/L, p < 0.001; Peak: DKA: 0.66 nmol/L vs. non-DKA: 0.88 nmol/L, p < 0.001), a difference that persists at 12 months compared to non-DKA participants (AUC: DKA: 0.42 nmol/L vs. non-DKA: 0.52 nmol/L, p < 0.003; Peak: DKA: 0.51 nmol/L vs. non-DKA: 0.71 nmol/L, p < 0.001).