TY - JOUR
T1 - Incidence, characteristics, risk factors and outcomes of diabetic ketoacidosis in COVID-19 patients
T2 - Comparison with influenza and pre-pandemic data
AU - Dell'Aquila, Kevin
AU - Lee, Jeylin
AU - Wang, Stephen H.
AU - Alamuri, Tharun T.
AU - Jennings, Rebecca
AU - Tang, Helen
AU - Mahesh, Sandhya
AU - Leong, Taylor Jan
AU - Fleysher, Roman
AU - Henninger, Erin M.
AU - Veeraraghavan, Sudhakar
AU - Mirhaji, Parsa
AU - Hou, Wei
AU - Herold, Kevan C.
AU - Duong, Tim Q.
N1 - Publisher Copyright:
© 2023 John Wiley & Sons Ltd.
PY - 2023/9
Y1 - 2023/9
N2 - Aims: This study characterized incidence, patient profiles, risk factors and outcomes of in-hospital diabetic ketoacidosis (DKA) in patients with COVID-19 compared with influenza and pre-pandemic data. Methods: This study consisted of 13 383 hospitalized patients with COVID-19 (March 2020-July 2022), 19 165 hospitalized patients with influenza (January 2018-July 2022) and 35 000 randomly sampled hospitalized pre-pandemic patients (January 2017-December 2019) in Montefiore Health System, Bronx, NY, USA. Primary outcomes were incidence of in-hospital DKA, in-hospital mortality, and insulin use at 3 and 6 months post-infection. Risk factors for developing DKA were identified. Results: The overall incidence of DKA in patients with COVID-19 and influenza, and pre-pandemic were 2.1%, 1.4% and 0.5%, respectively (p <.05 pairwise). Patients with COVID-19 with DKA had worse acute outcomes (p <.05) and higher incidence of new insulin treatment 3 and 6 months post-infection compared with patients with influenza with DKA (p <.05). The incidence of DKA in patients with COVID-19 was highest among patients with type 1 diabetes (12.8%), followed by patients with insulin-dependent type 2 diabetes (T2D; 5.2%), non-insulin dependent T2D (2.3%) and, lastly, patients without T2D (1.3%). Patients with COVID-19 with DKA had worse disease severity and higher mortality [odds ratio = 6.178 (4.428-8.590), p <.0001] compared with those without DKA. Type 1 diabetes, steroid therapy for COVID-19, COVID-19 status, black race and male gender were associated with increased risk of DKA. Conclusions: The incidence of DKA was higher in COVID-19 cohort compared to the influenza and pre-pandemic cohort. Patients with COVID-19 with DKA had worse outcomes compared with those without. Many COVID-19 survivors who developed DKA during hospitalization became insulin dependent. Identification of risk factors for DKA and new insulin-dependency could enable careful monitoring and timely intervention.
AB - Aims: This study characterized incidence, patient profiles, risk factors and outcomes of in-hospital diabetic ketoacidosis (DKA) in patients with COVID-19 compared with influenza and pre-pandemic data. Methods: This study consisted of 13 383 hospitalized patients with COVID-19 (March 2020-July 2022), 19 165 hospitalized patients with influenza (January 2018-July 2022) and 35 000 randomly sampled hospitalized pre-pandemic patients (January 2017-December 2019) in Montefiore Health System, Bronx, NY, USA. Primary outcomes were incidence of in-hospital DKA, in-hospital mortality, and insulin use at 3 and 6 months post-infection. Risk factors for developing DKA were identified. Results: The overall incidence of DKA in patients with COVID-19 and influenza, and pre-pandemic were 2.1%, 1.4% and 0.5%, respectively (p <.05 pairwise). Patients with COVID-19 with DKA had worse acute outcomes (p <.05) and higher incidence of new insulin treatment 3 and 6 months post-infection compared with patients with influenza with DKA (p <.05). The incidence of DKA in patients with COVID-19 was highest among patients with type 1 diabetes (12.8%), followed by patients with insulin-dependent type 2 diabetes (T2D; 5.2%), non-insulin dependent T2D (2.3%) and, lastly, patients without T2D (1.3%). Patients with COVID-19 with DKA had worse disease severity and higher mortality [odds ratio = 6.178 (4.428-8.590), p <.0001] compared with those without DKA. Type 1 diabetes, steroid therapy for COVID-19, COVID-19 status, black race and male gender were associated with increased risk of DKA. Conclusions: The incidence of DKA was higher in COVID-19 cohort compared to the influenza and pre-pandemic cohort. Patients with COVID-19 with DKA had worse outcomes compared with those without. Many COVID-19 survivors who developed DKA during hospitalization became insulin dependent. Identification of risk factors for DKA and new insulin-dependency could enable careful monitoring and timely intervention.
KW - beta cell function
KW - cohort study
KW - glycaemic control
KW - type 1 diabetes
KW - type 2 diabetes
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U2 - 10.1111/dom.15120
DO - 10.1111/dom.15120
M3 - Article
C2 - 37254311
AN - SCOPUS:85161353805
SN - 1462-8902
VL - 25
SP - 2482
EP - 2494
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
IS - 9
ER -
