Nationwide Survey on Acute Complications of Type 1 Diabetes Conducted - Ketoacidosis and Severe Hypoglycemia Persist During Treatment
Key facts
- Nationwide Survey on Acute Complications of Type 1 Diabetes Conducted - Ketoacidosis and Severe Hypoglycemia Persist During Treatment
- A nationwide survey conducted by the Japan Diabetes Society revealed that even among type 1 diabetes patients undergoing insulin therapy, 7.8% have experienced ketoacidosis and 12.7% have experienced severe hypoglycemia. These acute complications were more frequent in patients with low endogenous insulin secretion. This study, based on 2019 data, suggests the importance of disseminating advanced therapies such as continuous glucose monitoring and developing treatments aimed at preserving pancreatic β-cell function.
- Source: PR Times
- Date: May 27, 2026
Direct answer
A nationwide survey conducted by the Japan Diabetes Society revealed that even among type 1 diabetes patients undergoing insulin therapy, 7.8% have experienced ketoacidosis and 12.7% have experienced severe hypoglycemia. These acute complications were more frequent in patients with low endogenous insulin secretion. This study, based on 2019 data, suggests the importance of disseminating advanced therapies such as continuous glucose monitoring and developing treatments aimed at preserving pancreatic β-cell function.
- Citation
- Nationwide Survey on Acute Complications of Type 1 Diabetes Conducted - Ketoacidosis and Severe Hypoglycemia Persist During Treatment (May 27, 2026), PR Times
- Source
- PR Times
- Date
- May 27, 2026
A nationwide survey conducted by the Japan Diabetes Society revealed that even among type 1 diabetes patients undergoing insulin therapy, 7.8% have experienced ketoacidosis and 12.7% have experienced severe hypoglycemia. These acute complications were more frequent in patients with low endogenous insulin secretion. This study, based on 2019 data, suggests the importance of disseminating advanced therapies such as continuous glucose monitoring and developing treatments aimed at preserving pancreatic β-cell function.
📋 Article Processing Timeline
- 📰 Published: May 27, 2026 at 14:00
- 🔍 Collected: June 1, 2026 at 00:35 (106h 35m after Published)
- 🤖 AI Analyzed: June 2, 2026 at 08:21 (31h 45m after Collected)
The Japan Diabetes Society's 'Research Committee on the Development of Appropriate Treatment Based on the Analysis of the Actual State of Type 1 Diabetes in Japan' has conducted a nationwide survey on acute complications of type 1 diabetes through its registry subcommittee. [Responsible persons: Committee member Daisuke Chujo (International University of Health and Welfare), Registry subcommittee leader Akihisa Imagawa (Osaka Medical and Pharmaceutical University), Committee chairman Akira Shimada (Saitama Medical University)].
The results showed that 7.8% of type 1 diabetes patients receiving insulin therapy had experienced ketoacidosis during treatment, and 12.7% had experienced severe hypoglycemia requiring assistance from others. Furthermore, it was found that the patient group that had experienced these acute complications had significantly lower endogenous insulin secretion from their own pancreas compared to the group that had not.
This survey, conducted using outpatient data from 2019, showed that a certain percentage of patients experience severe, life-threatening acute complications even under insulin therapy. This is an important finding that illustrates the current state of type 1 diabetes treatment in Japan, and also suggests the importance of more actively utilizing glucose management therapies that have continued to evolve since the time of the survey.
This research was published in the international academic journal 'Journal of Diabetes Investigation' (dated April 8, 2026).
Background
Type 1 diabetes [1] is a form of diabetes that occurs mainly due to an autoimmune [2] process where the body's insulin-producing cells (pancreatic β-cells) are destroyed, leading to insufficient insulin secretion. It is a condition distinct from lifestyle-related diseases. Insulin therapy is generally necessary, but despite the advent of various insulin preparations and advancements in administration methods, life-threatening acute complications can still occur. This is a major challenge in the treatment of type 1 diabetes, and until now, there has been no nationwide survey on its incidence rate and associated factors.
The Japan Diabetes Society (JDS) established the 'Research Committee on the Development of Appropriate Treatment Based on the Analysis of the Actual State of Type 1 Diabetes in Japan' (Chairman: Akira Shimada) in 2019. The committee uses various databases to clarify the actual state of type 1 diabetes care in Japan and considers countermeasures based on the results. The survey announced this time was conducted as one of the committee's projects.
Research Methods and Results
Subjects
In this study, 4,405 type 1 diabetes patients who visited 125 medical institutions nationwide between November and December 2019 were registered. Of these, 2,679 patients who were clearly classified as having either acute-onset, slowly progressive, or fulminant type 1 diabetes were included in the analysis. The average age of the subjects was 50.0 years, and 42.0% were male.
Methods
Using an electronic data capture system, data on patient background, type of type 1 diabetes, age of onset, duration of insulin therapy, HbA1c levels, fasting serum C-peptide levels [3] (an indicator of endogenous insulin secretion), islet-related autoantibodies [4], history of diabetic ketosis/ketoacidosis [5], history of severe hypoglycemia [6], details of insulin therapy, and glucose management indicators from continuous glucose monitors were collected from participating medical institutions. The collected data were then used to analyze the proportion of patients who had experienced acute complications such as ketoacidosis and severe hypoglycemia, and the clinical factors that could influence their onset.
Main Results
At the onset of type 1 diabetes, 53.1% of patients had diabetic ketosis and 33.0% had diabetic ketoacidosis. Furthermore, even after starting insulin therapy, 18.8% of patients experienced ketosis and 7.8% experienced ketoacidosis. These post-onset complications were associated with high recent HbA1c levels, long-term insulin therapy, and low recent C-peptide levels.
Severe hypoglycemia was observed in 12.7% of patients (4.1% within the past year), and hypoglycemia unawareness in 28.9%. Both were associated with long-term insulin therapy, low recent C-peptide levels, and longer periods of hypoglycemia as measured by continuous glucose monitors.
Overall, slowly progressive type 1 diabetes had a relatively lower frequency of acute complications compared to other types. However, 'definite' cases of slowly progressive type 1 diabetes with fasting C-peptide levels below 0.6 ng/mL experienced ketoacidosis, severe hypoglycemia, and hypoglycemia unawareness at a frequency similar to that of acute-onset and fulminant types.
Conclusion
This survey is the first comprehensive nationwide evaluation of acute diabetic complications in type 1 diabetes patients in Japan. It showed that life-threatening acute complications such as ketoacidosis and severe hypoglycemia persist at a certain frequency even under insulin therapy. It is particularly important that reduced pancreatic β-cell function, indicated by low C-peptide levels, is associated not only with ketoacidosis but also with severe hypoglycemia and hypoglycemia unawareness.
Based on these results, it is hoped that advanced device therapies, including insulin pumps with automated insulin delivery features, will become more widespread, and that continuous glucose monitors will be further utilized for detailed monitoring of glucose fluctuations. Also, since low endogenous insulin secretion was associated with the onset of acute complications, the development of immunomodulatory therapies aimed at preserving pancreatic β-cell function is anticipated.
Significance and Future Prospects
This research was made possible by the cooperation of many patients and the medical staff at participating institutions. The results suggest the importance of further disseminating advanced treatments in type 1 diabetes care in Japan and the need for social support to achieve this.
Based on the knowledge gained so far, this committee will continue to investigate the current situation and challenges in type 1 diabetes care, and will continue to work towards providing appropriate treatment for more patients.
The results showed that 7.8% of type 1 diabetes patients receiving insulin therapy had experienced ketoacidosis during treatment, and 12.7% had experienced severe hypoglycemia requiring assistance from others. Furthermore, it was found that the patient group that had experienced these acute complications had significantly lower endogenous insulin secretion from their own pancreas compared to the group that had not.
This survey, conducted using outpatient data from 2019, showed that a certain percentage of patients experience severe, life-threatening acute complications even under insulin therapy. This is an important finding that illustrates the current state of type 1 diabetes treatment in Japan, and also suggests the importance of more actively utilizing glucose management therapies that have continued to evolve since the time of the survey.
This research was published in the international academic journal 'Journal of Diabetes Investigation' (dated April 8, 2026).
Background
Type 1 diabetes [1] is a form of diabetes that occurs mainly due to an autoimmune [2] process where the body's insulin-producing cells (pancreatic β-cells) are destroyed, leading to insufficient insulin secretion. It is a condition distinct from lifestyle-related diseases. Insulin therapy is generally necessary, but despite the advent of various insulin preparations and advancements in administration methods, life-threatening acute complications can still occur. This is a major challenge in the treatment of type 1 diabetes, and until now, there has been no nationwide survey on its incidence rate and associated factors.
The Japan Diabetes Society (JDS) established the 'Research Committee on the Development of Appropriate Treatment Based on the Analysis of the Actual State of Type 1 Diabetes in Japan' (Chairman: Akira Shimada) in 2019. The committee uses various databases to clarify the actual state of type 1 diabetes care in Japan and considers countermeasures based on the results. The survey announced this time was conducted as one of the committee's projects.
Research Methods and Results
Subjects
In this study, 4,405 type 1 diabetes patients who visited 125 medical institutions nationwide between November and December 2019 were registered. Of these, 2,679 patients who were clearly classified as having either acute-onset, slowly progressive, or fulminant type 1 diabetes were included in the analysis. The average age of the subjects was 50.0 years, and 42.0% were male.
Methods
Using an electronic data capture system, data on patient background, type of type 1 diabetes, age of onset, duration of insulin therapy, HbA1c levels, fasting serum C-peptide levels [3] (an indicator of endogenous insulin secretion), islet-related autoantibodies [4], history of diabetic ketosis/ketoacidosis [5], history of severe hypoglycemia [6], details of insulin therapy, and glucose management indicators from continuous glucose monitors were collected from participating medical institutions. The collected data were then used to analyze the proportion of patients who had experienced acute complications such as ketoacidosis and severe hypoglycemia, and the clinical factors that could influence their onset.
Main Results
At the onset of type 1 diabetes, 53.1% of patients had diabetic ketosis and 33.0% had diabetic ketoacidosis. Furthermore, even after starting insulin therapy, 18.8% of patients experienced ketosis and 7.8% experienced ketoacidosis. These post-onset complications were associated with high recent HbA1c levels, long-term insulin therapy, and low recent C-peptide levels.
Severe hypoglycemia was observed in 12.7% of patients (4.1% within the past year), and hypoglycemia unawareness in 28.9%. Both were associated with long-term insulin therapy, low recent C-peptide levels, and longer periods of hypoglycemia as measured by continuous glucose monitors.
Overall, slowly progressive type 1 diabetes had a relatively lower frequency of acute complications compared to other types. However, 'definite' cases of slowly progressive type 1 diabetes with fasting C-peptide levels below 0.6 ng/mL experienced ketoacidosis, severe hypoglycemia, and hypoglycemia unawareness at a frequency similar to that of acute-onset and fulminant types.
Conclusion
This survey is the first comprehensive nationwide evaluation of acute diabetic complications in type 1 diabetes patients in Japan. It showed that life-threatening acute complications such as ketoacidosis and severe hypoglycemia persist at a certain frequency even under insulin therapy. It is particularly important that reduced pancreatic β-cell function, indicated by low C-peptide levels, is associated not only with ketoacidosis but also with severe hypoglycemia and hypoglycemia unawareness.
Based on these results, it is hoped that advanced device therapies, including insulin pumps with automated insulin delivery features, will become more widespread, and that continuous glucose monitors will be further utilized for detailed monitoring of glucose fluctuations. Also, since low endogenous insulin secretion was associated with the onset of acute complications, the development of immunomodulatory therapies aimed at preserving pancreatic β-cell function is anticipated.
Significance and Future Prospects
This research was made possible by the cooperation of many patients and the medical staff at participating institutions. The results suggest the importance of further disseminating advanced treatments in type 1 diabetes care in Japan and the need for social support to achieve this.
Based on the knowledge gained so far, this committee will continue to investigate the current situation and challenges in type 1 diabetes care, and will continue to work towards providing appropriate treatment for more patients.
FAQ
What are the main findings of this survey?
It revealed that among type 1 diabetes patients in Japan receiving insulin therapy, 7.8% had experienced ketoacidosis and 12.7% had experienced severe hypoglycemia, which are life-threatening acute complications.
What are the characteristics of patients prone to acute complications?
Patients with significantly reduced endogenous insulin secretion from their own pancreas (low C-peptide levels) and those with a long duration of insulin therapy tended to have a higher rate of experiencing complications.
When and how was this survey conducted?
It was conducted from November to December 2019, targeting 4,405 type 1 diabetes patients visiting 125 medical institutions nationwide, using an electronic data capture system.
What do the survey results suggest?
They indicate that serious complications persist even under insulin therapy, suggesting the importance of further disseminating advanced device therapies like insulin pumps and continuous glucose monitors, and developing new treatments to preserve pancreatic β-cell function.
Where were these research findings published?
They were published in the international academic journal 'Journal of Diabetes Investigation' on April 8, 2026.