1604-P: Understanding Perspectives of People with Type 1 Diabetes on Hyperketonemia, Diabetic Ketoacidosis (DKA), and Ketone Monitoring: A Qualitative Study in Adults

Introduction and Objective: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. This study explored awareness, experiences, and barriers to ketone monitoring among adults with T1D. Methods: We conducted 60-minute interviews with adults living with T1D. Semi-structured interviews explored experiences, knowledge, and perceptions related to hyperketonemia, DKA, and ketone monitoring. Interviews were recorded, transcribed, with qualitative data coded for analysis with the NVivo program. Data were analyzed thematically, using combined deductive and inductive approaches. Results: Data from the initial 15 participants (50% of total sample size) highlighted that, while participants recognize the importance of ketone monitoring, it is not prioritized in daily diabetes management. Although education on ketones begins at diagnosis, routine monitoring is uncommon. Ketone checks occur mainly when glucose levels are high, when feeling unwell, during illness, after prior DKA events, and when taking certain medications (e.g., steroids), with most relying on urine strips. Key barriers include inconvenience, expired strips, and physiologically delayed results, adding to the burden of self-management. Participants often use glucose as a proxy for ketones. Positive experiences with HCP support were noted, but clearer education and practical tools are needed to integrate ketone monitoring into routine care. Conclusion: Ketone monitoring and management is recognized as important but is an underutilized tool, with reliance on urine strips and practical challenges, contributing to inconsistent use. Belief that glucose and ketone levels have similar trends indicate an area requiring training. There is a clear need for education, actionable clinical guidance, and accessible, user-friendly tools to support proactive ketone monitoring, and reduce DKA risk. Disclosure J. Sherr: Other - research support, consultant, advisory board member; Current; Abbott Diabetes. Other - advisory board member, consultant; Current; Vertex Pharmaceuticals Incorporated. Consultant; Current; Ypsomed AG. Research Support; Current; Dexcom, Inc., JDRF, Provention Bio, Inc., National Institutes of Health. Other - research support, consultant, advisory board member; Current; Insulet Corporation, Medtronic. Research Support; Current; Sanofi. Advisory Panel; Current; sequel med tech. C. Wysham: Advisory Panel; Current; Abbott Diabetes. Speaker's Bureau; Current; Abbott Diabetes. Research Support; Ended; AbbVie Inc., Bayer AG, Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk. Advisory Panel; Current; Eli Lilly and Company. Research Support; Ended; Eli Lilly and Company. Speaker's Bureau; Current; Eli Lilly and Company. Stock/Shareholder; Current; Pendulum. Speaker's Bureau; Ended; MannKind Corporation. R.M. Bergenstal: Other - Advisory Panel, Consultant, Clinical Research Support; Current; Abbott Diabetes. Other - Consultant, Clinical Research Support; Current; Dexcom, Inc. Research Support; Current; Amgen Inc. Advisory Panel; Current; CeQur SA. Other - Advisory Panel, Consultant, Clinical Research Support; Current; Eli Lilly and Company. Research Support; Current; Insulet Corporation. Research Support; Ended; Luna. Research Support; Current; Medtronic. Other - Advisory Panel, Consultant, Clinical Research Support; Current; Novo Nordisk. Research Support; Current; Tandem Diabetes Care, Inc. Consultant; Current; Sanofi. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. Research Support; Current; Zealand Pharma A/S, Sequel, Embecta. A. Albanese-O'Neill: Consultant; Current; Sanofi. Advisory Panel; Current; Roche Pharmaceuticals, Vertex Pharmaceuticals Incorporated. Research Support; Current; Abbott Diabetes. J. Rosen: Stock/Shareholder; Current; Amgen Inc., Arcus. Advisory Panel; Current; Bayer AG. K.A. Willoughby: Employee; Current; T1D Exchange. R. Wilson: Other - Rozanne Wilson is employed by Precision AQ, a consulting firm that was contracted by Sanofi to conduct research services related to the project. She did not receive direct compensation from Sanofi outside of her regular salary.; Current; Sanofi. A. Lee: Employee; Current; Abbott Diabetes. Y. Poon: Employee; Current; Abbott Diabetes. Stock/Shareholder; Current; Abbott Diabetes. Funding Abbott Diabetes Care