Previous studies have also shown that about half of adolescents with T2D eventually require insulin and 10% present with diabetic ketoacidosis (with even higher rates of both among individuals with new-onset T2D during the COVID-19 pandemic), reinforcing the notion that adolescents with T2D have a higher degree of insulin deficiency compared with adults.37,38,39,40. This evidence concerns the gene INS and diabetic ketoacidosis.