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Detectable C-Peptide and Diabetic Ketoacidosis Risk in Type 1 Diabetes.

Mohammad I Abuabat·Dalton Budhram·Priya Bapat·Abdulmohsen Bakhsh·Yucheng Zhang·Wajeeha Cheema·Natasha J Verhoeff·Doug Mumford·Andrej Orszag·Michael Fralick·Alanna Weisman·Leif Erik Lovblom·Bruce A Perkins
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Abstract

OBJECTIVE: To investigate whether detectable C-peptide levels in type 1 diabetes is associated with a lower risk of diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS: We analyzed the Diabetes Control and Complications Trial publicly available data repository for the association between detectable stimulated C-peptide (>0.2 nmol/mL, measured annually) and DKA incidence over an average 6.5-year follow-up. We used crude and adjusted Andersen-Gill models for recurrent DKA events with time-dependent covariates. RESULTS: Of the 1,441 participants (53% male, median age 27 years), 129 (9%) experienced 180 DKA events. Of these events, 179 (99.44%) occurred after C-peptide was ≤0.2 nmol/L in the prior year and only 1 event occurred with C-peptide >0.2 nmol/L. C-peptide >0.2 nmol/L was associated with a DKA hazard ratio of 0.07 (95% CI 0.01-0.48; P = 0.007), consistent across adjusted models. CONCLUSIONS: Endogenous insulin production was significantly associated with lower DKA risk, suggesting that treatments preserving insulin production could decrease long-term DKA risk.

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C-PeptideDiabetic KetoacidosisDiabetes Mellitus, Type 1IncidenceFollow-Up StudiesRisk FactorsInsulinRandomized Controlled Trials as TopicRetrospective StudiesHumansMaleFemaleAdultHypoglycemic AgentsJournal ArticleObservational Study

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Mohammad I Abuabat, Dalton Budhram, Priya Bapat, Abdulmohsen Bakhsh, Yucheng Zhang, Wajeeha Cheema, Natasha J Verhoeff, Doug Mumford, Andrej Orszag, Michael Fralick, Alanna Weisman, Leif Erik Lovblom, Bruce A Perkins. 2026-09-01. Detectable C-Peptide and Diabetic Ketoacidosis Risk in Type 1 Diabetes.. https://doi.org/10.2337/dc26-0220

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Adult subjectFemale subjectFollow-Up Studies subjectHumans subjectIncidence subjectJournal Article subjectJournal Article; Observational Study resourceMale subjectObservational Study subject

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