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Aims To determine if access to mobile phone support for sick-day management is associated with reduced hospital admissions with diabetic ketoacidosis in young adults aged 15-25 with Type 1 diabetes. Methods This was an observational study with data collected prospectively from January 2005 to December 2008. Amobile phone support service for sick-day management began in May 2005. Data from clinic attendees (group 1), including age, sex, diabetes duration, referral age, insulin therapy delivery, clinic attendance and HbA1c,were compared with clinic attendees with diabetic ketosis accessing sick-day management phone support (group 2), clinic attendees not accessing phone support and admitted with diabetic ketoacidosis (group 3) and non-clinic attendees admitted with diabetic ketoacidosis (group 4). Results Age was similar in all groups. Patients in group 3 had significantly shorter duration of diabetes (6.8 ± 3.1 years) than groups 1 or 2 (10.1 and 9.8 years, respectively). Diabetes control was poor in all presentations of diabetic ketoacidosis (groups 2-4, HbA1c > 97 mmol/ mol, > 11%) and was significantly higher than clinic attendees without ketosis (HbA1c 70 mmol / mol, 8.6%; P < 0.001). There was similar attendance at the clinic across all three groups, 2.9 compared with 2.4 compared with 2.1 visits / year, respectively. Thirty-one patients accessed phone support on 83 occasions for sick-day management (mean 2.7 contacts / episode); two patients progressed to admission with diabetic ketoacidosis. Diabetic ketoacidosis admission rates in the clinic population fell significantly from baseline, 0.10 to 0.05 admissions per patient per year (P < 0.05) in the third year. Conclusion Mobile phone support is associated with reduced progression of ketosis to diabetic ketoacidosis in young adults despite poor diabetes control. [ABSTRACT FROM AUTHOR]