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Hyperglycemic Crises in Adults With Diabetes: A Consensus Report
Open accessAbstract
The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE), and Diabetes Technology Society (DTS) convened a panel of internists and diabetologists to update the ADA consensus statement on hyperglycemic crises in adults with diabetes, published in 2001 and last updated in 2009. The objective of this consensus report is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment, and prevention of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes health care professionals and individuals with diabetes.
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“A BHB level of 3.0 mmol/L is necessary but not sufficient for the diagnosis of diabetic ketoacidosis, which also requires evidence of acidosis.7”
From Time to Moderate and Severe Hyperglycemia and Ketonemia Following an Insulin Pump Occlusion (2024) · cites this paper as [7]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Risk factors for DKA in individuals with either type 1 or type 2 diabetes treated with SGLT inhibitors include very-low-carbohydrate diets, prolonged fasting, dehydration, excessive alcohol intake, and other common precipitating factors (84,236).”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [236]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) are serious, acute, and life-threatening hyperglycemic emergencies (162).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [162]
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“Occasionally, people with type 2 diabetes may present with DKA (37), particularly members of certain racial, ethnic, and ancestral groups (e.g., African American and Hispanic/Latino adults), who may present with ketosisprone type 2 diabetes (30).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [30]
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In the citing paper
“Individuals with type 1 diabetes (84,236) and insulin-deficient type 2 diabetes are at increased risk for DKA with SGLT inhibitor therapy.”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [236]
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“There is considerable variability in the presentation of DKA and HHS”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [165]
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“potentially because of delayed diagnosis and treatment (165).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [165]
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“Importantly, approximately 10% of people experiencing DKA present with euglycemic DKA (plasma glucose <200 mg/dL [<11.1 mmol/L]); therefore, DKA diagnosis requires either the presence of hyperglycemia or prior history of diabetes (165).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [165]
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“DKA and the hyperglycemic hyperosmolar state (HHS) are serious, acute, and lifethreatening hyperglycemic emergencies in individuals with diabetes (165) that incur substantial morbidity, mortality, and costs (166).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [165]
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“Mortality rates reported in low-and middle-income countries are much higher than those in developed countries”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [165]
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Metadata
- Authors
- Umpierrez, G. E., Davis, G. M., ElSayed, N. A., Fadini, G. P., Galindo, R. J., Hirsch, I. B., Klonoff, D. C., McCoy, R. G., Misra, S., Gabbay, R. A., Bannuru, R. R., & Dhatariya, K. K.
- Affiliations
- Emory University (US)
- American Diabetes Association (US)
- University of Padua (IT)
- University of Miami (US)
- University of Washington (US)
- 8Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA
- University of Maryland, Baltimore (US)
- Imperial College Healthcare NHS Trust (GB)
- University of East Anglia (GB)
- Corresponding author
- Umpierrez, Guillermo E.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2024-06-22
- Volume
- 47
- Issue
- 8
- Pages
- 1257-1275
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC11272983
- OpenAlex
- W4399923484
- Cited by
- 278
- References
- 185
- Citations by year
- 2026: 129 · 2025: 131 · 2024: 18
- FWCI
- 91.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- NIH
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetic ketoacidosis, hyperosmolar hyperglycemic state, adults with diabetes, pathophysiology, clinical features, diagnosis, treatment, prevention, clinical guidelines
- MeSH terms
- Adult, Diabetes Mellitus, Humans, Hyperglycemia, Hyperglycemic Hyperosmolar Nonketotic Coma, Diabetic Ketoacidosis
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