As described in the ‘Notes’ in these criteria, a state of ketosis
should be confirmed by the elevation of urine and/or serum ketone
bodies. It is noted that diabetic ketosis or ketoacidosis
might not be seen in patients in whom insulin therapy was
started immediately after the occurrence of hyperglycemia and/
or hyperglycemic symptoms. Furthermore, we added a comment
on the ‘honeymoon period’, which is observed in approximately
30% of patients with acute-onset type 1 diabetes7. We
also described a comment that ‘IAA should be evaluated before
or shortly after insulin therapy is initiated’, because IAA and
insulin antibodies developed by exposure to exogenous insulin
are currently indistinguishable.