Objective To explore the factors of acute myocardial injury in children with type 1 diabetes and diabetic ketoacidosis, and to establish a risk prediction model.Methods Retrospective analysis was made on the medical records of 146 children with type 1 diabetic ketoacidosis who were admitted to the hospital from July 2018 to July 2023. They were randomly divided into 116 training sets and 30 validation sets according to the 8:2 principle. Patients were categorized into a myocardial injury group and a non-myocardial injury group based on the presence of acute myocardial injury. Cardiac function indicators [cardiac troponin I (cTnI), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), N-terminal pro brain natriuretic peptide (NT proBNP) ], electrocardiogram indicators [P-wave dispersion, Q-wave dispersion, QT interval], and blood cells [white blood cells, red blood cells, neutrophils, hemoglobin, platelet count] were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent risk factors for acute myocardial injury in children with type 1 diabetes and diabetic ketoacidosis and to validate the predictive value of the model.Results Among 146 children with type 1 diabetic ketoacidosis, 16 cases were complicated with acute myocardial injury, including 12 cases in the training set and 4 cases in the validation set. The cTnI, CK-MB, and NT proBNP levels in the merged group were higher than those in the non merged group (P < 0.05), while there was no statistically significant difference in CK levels between the two groups (P > 0.05). The P-wave dispersion, Q-wave dispersion, and QT interval of the merged group were higher than those of the non merged group (P < 0.05). The comparison of blood cell counts showed no statistically significant difference (P > 0.05). High levels of cTnI [O^R =4.870 (95% CI: 2.083, 11.386)], CK-MB [O^R =4.778 (95% CI: 2.043, 11.171) ], NT proBNP [O^R =4.702 (95% CI: 2.011, 10.994) ], P wave dispersion [O^R =4.601 (95% CI: 1.967, 10.754) ], Q wave dispersion [O^R =4.749 (95% CI: 2.031, 11.105) ], and QT interval [O^R =4.973 (95% CI: 2.127, 11.627) ] are all type 1 diabetic ketoacidosis risk factors of acute myocardial injury in children (P <0.05). The sensitivity of this risk model in the training set is 76.9% (95% CI: 0.714, 0.935), and the specificity is 85.9% (95% CI: 0.812, 0.932). Through ROC analysis, the sensitivity and specificity of this risk model in predicting acute myocardial injury in children with type 1 diabetic ketoacidosis were 77.2% (95% CI: 0.715, 0.908) and 83.7% (95% CI: 0.772, 0.925), respectively.Conclusion The changes of cTnI, CK-MB, NT proBNP, P-wave dispersion, Q-wave dispersion, and QT interval are independent risk factors for acute myocardial injury in children with type 1 diabetes and diabetic ketoacidosis. Building a risk prediction model is helpful to identify the occurrence risk of acute myocardial injury at an early stage.