DKA occurs when ketones build up in the blood to dangerous levels. According to Abbott, DKA is a leading cause of death for people under 58 with type 1 diabetes. While traditionally associated with type 1, it’s also increasingly affecting people with type 2 diabetes, the medtech giant says.
Findings from three studies showed significant gaps in the early detection of rising ketones among people with diabetes and healthcare providers. The studies took place across the UK, France and the U.S. Researchers found that DKA rates are rising while ketone monitoring remains inconsistent. That even proved true among highly-engaged users of diabetes technology.
Meanwhile, the company says that clinicians lacked guidance on how and when to intervene before DKA develops. Altogether, the findings, presented at the 19th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD) in Barcelona, highlight a dangerous and widening gap between awareness of DKA nad the ability to detect rising ketones early enough to prevent it.
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“These studies show a troubling reality: people are still missing the early rise in ketones that can quickly turn into diabetic ketoacidosis,” said Dr. Mahmood Kazemi, 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.”
Abbott, meanwhile, has a dual sensor that continuously monitors glucose and ketone levels at the same time under development. EVP of Diabetes Care Chris Scoggins explained the potential of the device in an interview with Drug Delivery Business News last year.
More on the findings from Abbott
Long-term UK analysis
A 23-year retrospective study of nearly 660,000 people with diabetes in the UK found that DKA rates have risen sharply among people living with type 1 and type 2 diabetes.
The analysis showed that incidence in adults with type 1 more than tripled over the study period. In type 2, DKA indidence increased sixfold. Abbott noted that, while some of the increases may reflect underreporting in earlier years, the overall trend shows a clear and sustained rise in DKA.
According to Abbott, the study also revealed high recurrence rates. Investigators found that 31.5% of people with type 1 and 12.1% of people with type 2 who experienced one DKA event went on to have another. Younger adults, women and individuals living in socioeconomically deprived areas faced disproportionately high risk.
“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 Dr. Pratik Choudhary, 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.”
Takeaways from the French study
Abbott said its French study revealed high awareness but low ketone testing frequency.
Its second study evaluated 553 adults with type 1 diabetes in the French SFDT1 cohort. It found that, while 95% of participants heard of ketosis, 91% were aware of DKA and more than half had experienced a prior DKA event, 38% still reported never testing ketones.
Abbott attributed the gap between awareness and action to a number of factors. Those include difficulty recognizing early symptoms and time burden. It observed those challenges even among advanced technology users. That includes those on continuous glucose monitors (CGMs) like Abbott’s FreeStyle Libre, as well as automated insulin delivery.
The study also found meaningful differences in how often clinicians encouraged ketone testing. People using multiple daily injections (MDI) of insulin were far more likely to report never being reminded to test and less likely to be prescribed ketone tests compared to those using pumps or automated systems.
According to Abbott, globally recognized guidelines recommend that anyone on intensive insulin therapy should check ketones when symptoms such as nausea, vomiting or dehydration occur. However, in this instance, the study made it clear that many failed to do so.
More from U.S. clinician interviews
The third and final study, using U.S. clinician interviews, showed wide variation in ketone monitoring practice. Healthcare providers described limited use of ketone data in routine care and inconsistent reliance on traditional testing methods. They reported wide variation in how they advise people to respond to rising ketones.
Even among specialists who routinely manage DKA, Abbott reports no consistent approach to when or how ketone monitoring should be used. The company says this underscores that the gaps extend beyond patient behavior to the clinical system itself.
Clinicians cited challenges including a lack of standardized guidance and incomplete or unavailable records. They also point to over-reliance on CGM trends, even though glucose levels do not reliably reflect ketone status.
Abbott said the variation means that many people may fail to receive clear or timely guidance on when to test ketones or seek care. This increases the risk of rising ketones going unnoticed until they become emergencies.
