PSAT035 COVID-19 Infection Increases DKA and mortality- A Harbinger for Increased Acute Diabetes Emergencies in the Future?

Abstract

Abstract DM patients infected with COVID-19 are at risk for developing severe complications including DKA and/or HHS, with a more severe disease course and higher mortality compared to those without DM or hyperglycemia. As COVID-19 is evolving into an endemic risk for the population, it is important to determine patients at risk for COVID-19 complications and outcomes. The Riverside University Health System Medical Center (RUHS-MC)-DKA Outcomes Group (RUDOG) initiated a study to characterize patients admitted for fatal DKA and/or HHS before and during the pandemic. This was a retrospective cohort study reviewing medical records of non-pregnant adults age 18 or older admitted to the RUHS-MC for DKA and/or HHS from Mar 2020 to Feb 2021 ("pandemic") compared to the 3 preceding years ("pre-pandemic"). The descriptive statistics were used to determine the clinical characteristics of hospitalized adult patients with DKA and/or HHS. Information of patient characteristics was extracted from chart reviews. Categorical data were compared using Fisher's Exact Test. Numerical variables were assessed using Mann-Whitney Test. The mortality rate during the pandemic was 8.4% (30/335) versus 1.7% (5/285) in the pre-pandemic period. Most of the deaths (24/30) were COVID infected. On average, the cases of deaths during pandemic had DM for a longer duration. There was no difference regarding age, race, HgbA1c on admission, insulin use history, and rate of micro- or macrovascular complications comparing these periods. More patients had HTN (80%) and HF (23%) during pandemic compared to pre-pandemic (69.2% and 7.7%, respectively). Infection was the cause of death for 63% and 31% of patients admitted for DKA and/or HHS during the pandemic versus pre-pandemic. There is a clear global concern that COVID-19 will be an endemic infectious disease placing people with pre-existing conditions such as DM at increased risk for morbidities and death. Our study has clearly demonstrated that contracting COVID is a risk for increased incidence of DKA and/or HHS and mortality compared to pre-pandemic levels. In addition, we have shown that certain pre-existing comorbidities are associated with the mortality of DKA and/or HHS including HTN and HF with COVID infection. The duration of DM was longer among patients that died during pandemic, regardless of age, race, or HgbA1c on admission. This finding is intriguing as we did not see increased DKA and/or HHS based on the number of micro- or macrovascular complications suggesting duration alone may be a new risk determinant. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.