RESULTS: 424 articles met the inclusion criteria; 65 covered economic burden. The identified literature highlighted the substantial economic burden of DKA in pediatrics and insulin pump-users to patients and healthcare systems, requiring extensive resource-use globally. Key findings included: in the US, annual average total costs of DKA hospital treatment per pediatric admission increased from $14,458 (2006) to $20,997 (2016); US patients requiring ICU admission accumulate an average per patient cost of $13,946 (2017); severe DKA increased hospital length-of-stay, often by ≥2 days; pediatric/adolescent DKA patients frequently spend 3-4 days in hospital (11-country average); in Canada, 25.5% pediatric hospitalizations for DKA included ICU stay; in Australia, lack of access to supported care during transition from pediatric to adult care had a substantial adverse impact on DKA admission rates and length-of-stay; in Israel, insulin-pump-users reported average 3.4 DKA-related hospital admissions per year; pump-users in Europe have an average length-of-stay of 8.1 days per DKA admission and in Wales, average total cost of treatment/year associated with DKA hospitalization of pump-users increased from £54,350 (2018) 2018 to £70,760 (2019). Study from the Netherlands highlighted that the most DKA cases among pump-users were due to device-related complications.