With increased emphasis on integrated care management for patients with diabetes, rates of diabetes-related complications have declined substantially in the past two decades. However, diabetic ketoacidosis (DKA), one of the most serious acute complications of diabetes, remains a significant cause of morbidity and mortality in clinical practice. China has the largest number of diabetes cases, however, there has been little research on the clinical profiles of patients with DKA episodes in the Chinese population. From a multicentre, clinic-based study between 2010 and 2012 in 15 tertiary medical centres around China, patients with Type 1, Type 2 and atypical diabetes were all at risk of being hospitalized with DKA. Type 2 and Type 1 diabetes contribute to a similar proportion of cases presenting with DKA. Although guidelines on the diagnosis and therapy of DKA have been launched, significant gaps remain in translating the current knowledge to the bedside, especially in relation to the classification of diabetes, fluid supplementation and bicarbonate therapy. Admissions with DKA in China were still associated with significant mortality and prolonged hospitalization. In another multicentre registration study of patients with established type 1 diabetes from 16 centres in Guangdong Province, China, the incidence of secondary DKA was 26.4/100 patient-years. Significant risk factors for secondary DKA were female gender, medical reimbursement rate <50% , uncontrolled diet, smoking and poor glycaemic control. Overweight/obesity was a protective factor. Additionally, 34.4% of secondary DKA occurred in 3.8% patients with recurrent events. The results indicate that secondary DKA occur at high rates in Chinese patients with established T1DM and that recurrence is likely to occur in high-risk patients. The efficiency of DKA management needs to be improved by implementing the updated guidelines.