Abstract
Background: COVID-19 in people with diabetes is associated with poorer outcomes. Diabetic Ketoacidosis (DKA) is an acute complication of diabetes with a mortality rate of 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 with DKA.Methods: This retrospective cohort study included all patients with DKA between 01 March 2020 and 30 May 2020. Patients were categorised as COVID-positive or COVID-negative. A pre-COVID group was established using data from 01 March 2019 to 30 May 2019 as control. Data regarding demographics, diabetes type, admission pH, bicarbonate, lactate, glucose, serum electrolytes, urea, creatinine, time to DKA resolution, complications, and outcome were collected.Findings: A total of 88 episodes (20 COVID-positive, 31 COVID-negative and 37-pre-COVID) were included in this study. There was no significant difference in the severity or duration of DKA between the three groups. COVID-positive type 1 diabetes (T1DM) were more hyperglycaemic on admission compared to COVID-negative and pre-COVID patients. There was an over representation of type 2 diabetes (T2DM) in COVID-positive patients than in pre-COVID or COVID-negative groups.Interpretation: COVID-19 appears to influence the natural history of DKA differently in T1DM and T2DM. In patients with T1DM, infection was associated with more hyperglycaemia and acidosis on presentation with DKA. Patients with T2DM were unusually presenting in DKA when infected with COVID-19. These patients were also more likely to need ITU with higher mortality rates. There is a need for a collaborative, multi-centre approach in order to conduct larger cohort studies to provide more definitive results.Funding: No funding was received for this work.Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: The study was registered as a retrospective audit and was approved by the hospital governance team with no further ethical input needed.
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