Young adults with type 1 diabetes (T1D) are bearing a disproportionate burden of diabetic ketoacidosis (DKA), according to a new real-world analysis of a French prospective cohort. Among 2,685 patients, 4.5% experienced at least one DKA episode in the year prior to their study visit — but the rate more than doubled among those aged 18–24, hitting 10.3%. By contrast, rates were 6.1% in children aged 7–13, 4.4% in teens aged 14–17, and just 3.5% in adults aged 25–64. No episodes were recorded in patients 65 and older.

Technology appears to be a meaningful safeguard. Patients using automated insulin delivery systems had lower DKA rates than those on open-loop pumps (3.1% vs. 5.4%), and continuous glucose monitoring (CGM) users fared better than fingerstick-only users (4.3% vs. 8.1%) — with CGM associated with a 49% lower likelihood of a DKA episode after adjustment. The study also flagged a troubling overlap: patients with a recent DKA episode were far more likely to report severe hypoglycemia requiring outside help (27.0% vs. 8.5%).

Key Takeaways:

• Young adults (18–24) had the highest DKA rate at 10.3% — nearly triple the rate seen in adults aged 25–64
• Automated insulin delivery was linked to lower DKA risk vs. open-loop pumps (3.1% vs. 5.4%)
• CGM use was associated with a 49% lower likelihood of DKA
• Severe hypoglycemia requiring outside assistance was more than three times as common in patients who had a recent DKA episode (27.0% vs. 8.5%)

Why it matters: The transition to adulthood is a high-risk period for T1D management, and this study underscores the urgent need for targeted education on ketone monitoring and broader access to diabetes technology for young adults — a group that may be slipping through the cracks of structured diabetes care.