Coronavirus disease (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 natural history of DKA in the presence of COVID-19 infection. This study aimed to explore the effects of COVID-19 infection on presentation, clinical course and outcome in patients presenting with DKA.
We undertook a retrospective cohort study of all people admitted with DKA in our institution from 01 March 2020 to 30 May 2020. Based on the SARS-Coronavirus-PCR test results, they were categorised into COVID-positive and COVID-negative groups. A pre-COVID group was established using data from 01 March 2019 to 30 May 2019 as an additional control. DKA was diagnosed as per Joint British Diabetes Society guidelines in the UK. For all patients, we recorded demographic data, diabetes type, various biochemical measurements at the time of admission, time to resolution of acidosis, time to resolution of ketosis, need for admission to ITU, length of stay and final outcome. The data were analysed using GraphPad Prism Version 6.07. One-way ANOVA was used to compare the differences between groups. P-values provided are two-tailed, and value of < 0.05 was considered as statistically significant.
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 (12.5 hours vs 14.9 hours vs 17.9 hours for COVID-positive, COVID-negative and pre-COVID groups respectively; COVID-positive vs. negative, P > 0.99; COVID-positive vs. pre-COVID, P = 0.8772; COVID-negative vs. pre-COVID P > 0.99). COVID-positive T1DM ([60 mmol/l (35.9–60.0)] were more hyperglycaemic on admission compared to COVID-negative ([31.4 mmol/l (28.0–39.1)] and pre-COVID groups ([24 mmol/l (20.2–33.75)]. There was an over representation of T2DM in COVID-positive group with DKA (n = 15/20) than in pre-COVID (n = 8/37) or COVID-negative groups (n = 2/31). Six people with COVID and four people without COVID required intensive care. Five (1/31 COVID-negative and 4/20 COVID-positive) died. In patients with T2DM, all deaths occurred in COVID-positive group.
COVID infection appears to influence the natural history of DKA differently in T1DM and T2DM. Patients with T1DM and COVID-19 presented with more hyperglycaemia. Patients with T2DM were unusually presenting in DKA when infected with COVID with more ITU need and higher mortality rates.