Introduction and Objective: Diabetic ketoacidosis (DKA) remains a common presentation of type 1 diabetes (T1D) and may reflect delayed diagnosis and greater metabolic decompensation. Whether DKA at diagnosis influences the early clinical trajectory of T1D remains unclear. We evaluated the association between DKA at diagnosis and clinical outcomes during the first three years after T1D diagnosis Methods: We conducted a retrospective cohort study of 160 individuals with newly diagnosed T1D followed at a tertiary diabetes center in Riyadh, Saudi Arabia. Participants were categorized by the presence or absence of DKA at diagnosis. Clinical characteristics and longitudinal outcomes were compared between groups over approximately three years of follow-up Results: Among 160 participants, 76 (47.5%) presented with DKA at diagnosis. Baseline age, age at time of diagnosis, sex, and A1C at the first visit in our clinic were similar between those with and without DKA at diagnosis. Individuals with DKA had higher urinary albumin-to-creatinine ratio (ACR) during their first visit in our clinic (191 vs 57 mg/g, p=0.04) and reported more frequent severe hypoglycemia (17.9% vs 4.6%, p=0.02). Overall A1C improved from 9.4% to 8.1% during follow-up. However, individuals with DKA at diagnosis maintained slightly higher A1C at the last visit compared with those without DKA (8.3% vs 8.0%). Urinary ACR also remained higher at the last visit in those with DKA at diagnosis (253 mg/g vs 101 mg/g). Conclusion: DKA at diagnosis was associated with higher baseline and follow up albuminuria, greater frequency of severe hypoglycemia, and slightly higher A1C during follow-up, suggesting a more vulnerable early clinical trajectory and highlighting the need for targeted follow-up and early risk stratification after T1D diagnosis Disclosure A.A. Alelaiwi: None. A. Alnasser: None. A.A. Badahdah: None. S.K. Alharthi: None. M.E. Al-Sofiani: Speaker's Bureau; Ended; Medtronic, Dexcom, Inc. Research Support; Current; Dexcom, Inc. Research Support; Ended; Medtronic. Speaker's Bureau; Ended; Insulet Corporation, Abbott Diabetes, Sanofi.
ALELAIWI et al. (Fri,) studied this question.