Comparison of Diabetic Ketoacidosis in Adults During the SARS-CoV-2 Outbreak and Over the Same Time Period for the Preceding 3 Years
Shivani Misra, Baktash Khozoee, Jiawei Huang, Kyriaki Mitsaki, Monika Reddy, Victoria Salem, Tricia Tan, George Tharakan, David Gable, Vassiliki Bravis, Jonathan Valabhji
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening metabolic decompensation occurring with any diabetes subtype, often precipitated by infection. During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, reports emerged suggesting that coronavirus disease 2019 (COVID-19) is associated with a higher frequency of DKA with atypical presentations (1,2) and led some to hypothesize a direct effect of SARS-CoV-2 on the pancreas itself (3). We addressed the observational bias of such reports by comparing DKA cases and characteristics in adults during the outbreak to matched 4-month periods (1 February–31 May) from 2017 to 2019 at a large London National Health Service (NHS) Trust. Analyzing 175 biochemically confirmed DKA cases, the 3-year average for patients admitted over the 4-month period was 44 (exact Poisson CI 32–59) vs. 43 (31–58) during the outbreak. Although adult medical admissions reduced by 33% (3-year average for the same time period 26,831 vs. 19,267), the proportion of individuals presenting with DKA during the outbreak was 0.22% of all admissions compared with a 3-year average of 0.16% ( P = 0.16). Among those presenting with DKA, the proportion with a diagnosis of type 2 diabetes during the SARS-CoV-2 outbreak was higher compared with the preceding 3 years (37% vs. 17%, P = 0.01) (Table 1), and proportion with type 1 diabetes reduced from 68% prepandemic to 44%. Adults with type 2 diabetes had a significantly higher proportion of positivity for SARS-CoV-2 than those with other types of diabetes—89% vs. 27%, respectively ( P = 0.009). …