DKA at type 1 diabetes onset in children is associated with subclinical cardiac involvement, reflected by elevated cardiac biomarkers, altered diastolic filling parameters, and reduced left ventricular global longitudinal strain.
Troponin I was significantly elevated in children with DKA compared to non-DKA at baseline.
NT-proBNP was significantly elevated in the DKA group compared to non-DKA at baseline.
Left ventricular global longitudinal strain (GLS) was significantly reduced in children with DKA compared to those without DKA.
Echocardiography demonstrated altered diastolic filling parameters in children with DKA.
Lower bicarbonate levels, reflecting greater DKA severity, were independently associated with higher troponin I and NT-proBNP in multivariable analysis.
The study enrolled 81 pediatric patients with new-onset type 1 diabetes, of whom 53.1% had DKA, in a prospective single-center cohort design.
This research suggests that when children develop type 1 diabetes and experience a dangerous complication called diabetic ketoacidosis (DKA) — a state of severe metabolic imbalance — their hearts show signs of stress, even if the children appear otherwise stable. The study followed 81 children and teenagers newly diagnosed with type 1 diabetes, about half of whom had DKA at diagnosis. Using blood tests for heart-stress proteins (troponin I and NT-proBNP) and detailed heart ultrasound scans including advanced 'strain' analysis, researchers found that children with DKA had higher levels of these cardiac stress markers and subtle differences in how their hearts pumped and filled with blood compared to children without DKA. Importantly, the more severe the acidosis (measured by lower bicarbonate levels in the blood), the higher the cardiac stress markers tended to be. The differences detected were largely subclinical — meaning they were measurable by sensitive tests but most values still fell within the normal range, and the children were not experiencing obvious heart failure or cardiac emergencies. The finding that a measure called global longitudinal strain (GLS) was reduced in the DKA group is particularly notable, as GLS is a sensitive indicator of early heart muscle dysfunction that can detect problems before standard echocardiography would. This research suggests that DKA in children causes real, detectable stress to the heart muscle during the acute phase of illness, and that standard assessments may underestimate this impact. Whether these subtle changes have any long-term consequences for heart health as these children grow older is unknown and would require studies with much longer follow-up periods. The findings highlight the importance of monitoring cardiac health during DKA and may eventually help guide more tailored treatment approaches.
Weiskorn J, Hotze S, von Gise A, Busse M, Kordonouri O. (2026). Subclinical cardiac involvement during diabetic ketoacidosis at type 1 diabetes onset in youth: biomarker elevation, altered diastolic filling, and reduced global longitudinal strain: a prospective cohort study.. Cardiovascular diabetology. https://doi.org/10.1186/s12933-026-03377-9