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

Research output: Contribution to journalArticlepeer-review

Authors

  • Agnes Johnson
  • Lucy Wallett
  • Lucretia Thomas
  • Dengyi Zhou
  • Catherine Holmes
  • Agata Juszczak
  • Mohammed Ali Karamat
  • Sandip Ghosh
  • Wasim Hanif
  • Srikanth Bellary

External organisations

  • University Hospitals Birmingham NHS Foundation Trust
  • Queen Elizabeth Hospital Birmingham, Queen Elizabeth Medical Centre
  • Aston University

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 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 preCOVID 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 [60mmol/l (35.9-60.0) vs. 31.4mmol/l (28.0-39.1) vs. 24mmol/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.

Details

Original languageEnglish
Pages (from-to)371–377
JournalEndocrine Connections
Volume10
Issue number4
Early online date5 Mar 2021
Publication statusPublished - Apr 2021