Life‐threatening acute complications persist among individuals with type 1 diabetes in Japan: A nationwide registry‐based cross‐sectional study

ABSTRACT Introduction Despite advances in insulin therapy, acute diabetic complications continue to pose a significant and potentially life‐threatening risk in type 1 diabetes. Since there have been no nationwide studies regarding acute diabetic complications in individuals with type 1 diabetes in Japan, we investigated the incidence of those complications and examined the association between the incidence and clinical factors in the patients. Materials and methods Registry‐based cross‐sectional analyses were conducted using data from patients with type 1 diabetes from 125 medical institutions across Japan. Results A total of 4,405 cases were registered in the database, of which 2,679 cases with confirmed diagnosis of type 1 diabetes subtypes were included in the analyses. Following insulin therapy, 18.8 and 7.8% of the patients experienced diabetic ketosis and diabetic ketoacidosis, respectively. Furthermore, 12.7 and 28.9% of the participants experienced severe hypoglycemia and hypoglycemic unawareness, respectively. C‐peptide levels were significantly lower in patients with these complications than in those without the complications. Notably, the incidence of these complications in patients with slowly progressive type 1 diabetes “definite” was comparable with those in patients with acute‐onset or fulminant type 1 diabetes. Conclusions A substantial proportion of patients with type 1 diabetes in Japan experience potentially life‐threatening acute diabetic complications despite receiving insulin replacement therapy. Advanced medical care for type 1 diabetes should be further developed in this country.