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

Punith Kempegowda; Eka Melson; Agnes Johnson; Lucy Wallett; Lucretia Thomas; Dengyi Zhou; Catherine Holmes; Agata Juszczak; Mohammed Ali Karamat; Sandip Ghosh; Wasim Hanif; Parth Narendran; Srikanth Bellary

doi:10.1530/ec-20-0567

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

Punith Kempegowda, Eka Melson, Agnes Johnson, Lucy Wallett, Lucretia Thomas, Dengyi Zhou, Catherine Holmes, Agata Juszczak, Mohammed Ali Karamat, Sandip Ghosh, Wasim Hanif, Parth Narendran, Srikanth Bellary

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	371-377
Number of pages	7
Journal	Endocrine Connections
Volume	10
Issue number	4
DOIs	https://doi.org/10.1530/ec-20-0567
Publication status	Published - Apr 2021

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10.1530/ec-20-0567Licence: CC BY-NC 4.0

Endocrine Connections] Effect of COVID-19 on the clinical course of diabetic ketoacidosis (DKA) in people with type 1 and type 2 diabetes
© 2021 The authors 2021. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Final published version, 1.34 MBLicence: CC BY-NC 4.0

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@article{95635c3e25c14b65b14a44b624873314,

title = "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.",

author = "Punith Kempegowda and Eka Melson and Agnes Johnson and Lucy Wallett and Lucretia Thomas and Dengyi Zhou and Catherine Holmes and Agata Juszczak and Karamat, {Mohammed Ali} and Sandip Ghosh and Wasim Hanif and Parth Narendran and Srikanth Bellary",

note = "{\textcopyright} 2021 The authors 2021. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.",

year = "2021",

month = apr,

doi = "10.1530/ec-20-0567",

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T1 - Effect of COVID-19 on the clinical course of diabetic ketoacidosis (DKA) in people with type 1 and type 2 diabetes

AU - Kempegowda, Punith

AU - Melson, Eka

AU - Johnson, Agnes

AU - Wallett, Lucy

AU - Thomas, Lucretia

AU - Zhou, Dengyi

AU - Holmes, Catherine

AU - Juszczak, Agata

AU - Karamat, Mohammed Ali

AU - Ghosh, Sandip

AU - Hanif, Wasim

AU - Narendran, Parth

AU - Bellary, Srikanth

PY - 2021/4

Y1 - 2021/4

N2 - 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.

AB - 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.

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DO - 10.1530/ec-20-0567

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C2 - 33666571

VL - 10

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EP - 377

JO - Endocrine Connections

JF - Endocrine Connections

IS - 4

ER -

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

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