Effect of COVID-19 on the clinical course of diabetic ketoacidosis (DKA) in people with type 1 and type 2 diabetes

Abstract

Objective COVID-19 in people with diabetes is associated with a disproportionately worse prognosis. DKA is an acute complication of diabetes with a mortality rate of approximately 0.67%. Little is known about the natural history of DKA in the presence of COVID-19. This study aimed to explore the effects of COVID-19 on presentation, clinical course and outcome in patients presenting with DKA. Design Retrospective cohort study. Methods All patients treated for DKA between 1 March 2020 and 30 May 2020 were included. Patients were categorised as COVID-positive or COVID-negative based on the swab test. A pre-COVID group was established using data from 01 March 2019 to 30 May 2019 as external control. Data regarding demographics, diabetes type, pH, bicarbonate, lactate, glucose, DKA duration, complications and outcome were collected. Results A total of 88 DKA episodes were included in this study. There was no significant difference in the severity or duration of DKA between the three groups. COVID-positive T1DM were more hyperglycaemic on admission compared to COVID-negative and pre-COVID patients. There was an over representation of T2DM in COVID-positive patients with DKA than in pre-COVID or COVID-negative groups. Conclusion COVID-19 appears to influence the natural history of DKA differently in T1DM and T2DM. Patients with T1DM and COVID-19 presented with more hyperglycaemia (60 mmol/L (35.9–60.0) vs 31.4 mmol/L (28.0–39.1) vs 24 mmol/L (20.2–33.75), respectively). Patients with T2DM were unusually presenting in DKA when infected with COVID-19 with greater ICU need and higher mortality rates. A collaborative, multi-centre study is needed to provide more definitive results.

Publication DOI: https://doi.org/10.1530/ec-20-0567
Divisions: College of Health & Life Sciences > School of Biosciences
Additional Information: © 2021 The authors 2021. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Full Text Link:
Related URLs: https://ec.bios ... /EC-20-0567.xml (Publisher URL)
PURE Output Type: Article
Published Date: 2021-04
Published Online Date: 2021-03-05
Accepted Date: 2021-03-05
Authors: Kempegowda, Punith
Melson, Eka
Johnson, Agnes
Wallett, Lucy
Thomas, Lucretia
Zhou, Dengyi
Holmes, Catherine
Juszczak, Agata
Karamat, Mohammed Ali
Ghosh, Sandip
Hanif, Wasim
Narendran, Parth
Bellary, Srikanth (ORCID Profile 0000-0002-5924-5278)

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