Introduction: Type 1 diabetes (T1D) presents acutely in children and adolescents, particularly in younger patients, with a very rapid progression to ketoacidosis. According to a study conducted about twenty years ago, the incidence of ketoacidosis at the time of diagnosis was 48% in France. Objectives: To evaluate the long-term effect of an information campaign and the role of primary care physicians in preventing ketoacidosis at the time of T1D diagnosis in children and adolescents. Patients and methods: The following data were collected from 146 pediatric departments among children under 15 years of age at the time of T1D diagnosis: age, gender, duration of symptoms, patient history prior to hospitalization, laboratory and clinical findings, and family history of T1D. Ketoacidosis was defined as a pH <7.30 or a base excess (BE) <15 mmol/L, and severe ketoacidosis as a pH <7.10 or BE <5 mmol/L. Following a baseline year (Year 0), an information campaign targeted healthcare professionals and the general public (Year 1), and changes in the incidence of ketoacidosis were assessed over the subsequent five years. Concurrently, questionnaires were completed by 1,467 general practitioners to assess their knowledge and practices regarding the diagnosis of T1D. Results: the incidence of ketoacidosis decreased from 14.8% (Year 0) to 11.3% (Year 1), but returned to its initial level two years later (Year 3). Data collected from general practitioners showed that only 47.6% of them had diagnosed T1D in a child or adolescent; 27.8% were unaware that T1D could develop before the age of 2; 8.3% stated that diabetic ketoacidosis was not life-threatening; the significance of certain symptoms (family history, urinary tract infection, etc.) was overestimated. The diagnostic criteria cited were more characteristic of type 2 diabetes than of type 1 diabetes, and the urgency of hospital care was too often overlooked. Conclusion: The lack of long-term impact from our campaign leads us to rethink our strategy for preventing ketoacidosis at the time of T1D diagnosis. Given their involvement, general practitioners must be informed about the specific characteristics of diabetes in children and adolescents, and the urgency of hospital care.