ObjectiveTo identify independent risk factors and predictive markers for acute pancreatitis (AP) in patients with diabetic ketoacidosis (DKA).MethodsHere, we reported a 11-year experience in a single tertiary medical center and conduct a systematic review of acute pancreatitis in diabetic ketoacidosis patients (DKA-AP). 1,941 cases were included. First retrospective cohort study analyzed clinical data from 45 patients with DKA-AP and 45 matched controls with DKA alone (DKA-nonAP) admitted to Yangzhou University Affiliated Hospital (2013–2024). Baseline characteristics included BMI, hyperlipidemia history, and serological profiles. Secondly we retrieved clinical studies of DKA-AP from PubMed database system and analyzed these clinical data in depth.ResultsSignificant differences were observed in BMI: median [IQR] = 26.30 [22.15–28.40] vs. 23.20 [20.70–25.35] kg/m2, p = 0.031, hyperlipidemia history (26.7% vs. 4.4%, p = 0.004), abdominal pain duration (3 vs. 0 days, p