Infection was the most common trigger overall (32.6%), followed by insulin non-compliance (13.7%), pancreatitis (4.7%), and surgery (2.3%); precipitating factors had a similar trend in both EuDKA and hDKA except for infections, which was more in hDKA patients compared to EuDKA (RR 2.53, 95% CI 1.07–5.98 p value 0.006). The gene discussed is INS; the disease is pancreatitis.