Hyperglycaemic crises in adults with diabetes: a consensus report Hyperglycaemic crises, such as diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS), are serious, acute, and life-threatening conditions in adults with type 1 and type 2 diabetes. This consensus report, developed by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and other organizations, provides updated information on the epidemiology, pathophysiology, clinical presentation, and management of DKA and HHS. The report includes new recommendations based on a systematic review of literature since 2009. DKA is characterized by hyperglycaemia, elevated ketone levels, and metabolic acidosis, while HHS is marked by severe hyperglycaemia, hyperosmolality, and dehydration without significant ketosis or acidosis. Both conditions can occur in people with any type of diabetes, with DKA more common in young people with type 1 diabetes and HHS more frequently in older adults with type 2 diabetes. Common precipitating factors include infections, stress, and insulin omission, while SGLT2 inhibitors have been linked to increased DKA risk. The report highlights the rising incidence of DKA and HHS, particularly in younger adults and those with type 2 diabetes. DKA mortality has decreased but remains higher in HHS. Risk factors include socioeconomic status, mental health, and comorbidities. The management of DKA and HHS involves fluid replacement, insulin therapy, and treatment of underlying causes. Insulin therapy is the cornerstone of treatment, with continuous infusion being preferred. Fluid resuscitation with isotonic saline or balanced crystalloid solutions is recommended, with adjustments based on patient response. The report also discusses the importance of early diagnosis and management to improve outcomes. It emphasizes the need for careful monitoring of potassium levels, as hypokalaemia can be life-threatening. Bicarbonate administration is not recommended for DKA. The report provides detailed guidelines on the diagnosis, treatment, and prevention of DKA and HHS, with a focus on improving patient outcomes and reducing mortality.Hyperglycaemic crises in adults with diabetes: a consensus report Hyperglycaemic crises, such as diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS), are serious, acute, and life-threatening conditions in adults with type 1 and type 2 diabetes. This consensus report, developed by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and other organizations, provides updated information on the epidemiology, pathophysiology, clinical presentation, and management of DKA and HHS. The report includes new recommendations based on a systematic review of literature since 2009. DKA is characterized by hyperglycaemia, elevated ketone levels, and metabolic acidosis, while HHS is marked by severe hyperglycaemia, hyperosmolality, and dehydration without significant ketosis or acidosis. Both conditions can occur in people with any type of diabetes, with DKA more common in young people with type 1 diabetes and HHS more frequently in older adults with type 2 diabetes. Common precipitating factors include infections, stress, and insulin omission, while SGLT2 inhibitors have been linked to increased DKA risk. The report highlights the rising incidence of DKA and HHS, particularly in younger adults and those with type 2 diabetes. DKA mortality has decreased but remains higher in HHS. Risk factors include socioeconomic status, mental health, and comorbidities. The management of DKA and HHS involves fluid replacement, insulin therapy, and treatment of underlying causes. Insulin therapy is the cornerstone of treatment, with continuous infusion being preferred. Fluid resuscitation with isotonic saline or balanced crystalloid solutions is recommended, with adjustments based on patient response. The report also discusses the importance of early diagnosis and management to improve outcomes. It emphasizes the need for careful monitoring of potassium levels, as hypokalaemia can be life-threatening. Bicarbonate administration is not recommended for DKA. The report provides detailed guidelines on the diagnosis, treatment, and prevention of DKA and HHS, with a focus on improving patient outcomes and reducing mortality.