It can be explained by different levels of disease awareness and healthcare provision, in countries with a low incidence of T1DM, the awareness of DKA tends to be low while the rate of DKA is high, conversely, in countries with higher incidence and prevalence rates of T1DM, people are more effective in the detection of symptoms of new-onset T1DM prior to DKA, and then many children with new-onset T1DM receive insulin therapy in time to avoid DKA. Here, INS is linked to type 1 diabetes mellitus.