COVID-19 and emergencies in patients with diabetes: two case reports

Abstract

Background Maldives reported its first Coronavirus disease 2019 (COVID-19) case on March 7th, 2020. Since then more than 9400 positive cases and 33 deaths have been reported. Recently studies have shown that COVID-19 patients with diabetes had a poor prognosis and a higher mortality rate when compared to the non-diabetic patients. Poorly controlled diabetic patients had a higher incidence of complications like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) which might have been precipitated by COVID-19. DKA and HHS are potentially lethal but preventable conditions. During this pandemic, although cases of uncontrolled diabetes are frequently reported, there is scarcity in reporting of cases with diabetic emergencies. Case presentation Case 1 was a 53-year old Asian male, admitted on Day 10th of illness with DKA with acute kidney injury, and Moderate COVID-19. Case 2 was a 72-year old Asian male, admitted with mild COVID-19 who developed HHS with acute kidney injury on day 9 of illness. Both patients were managed conservatively in intensive care unit, with intravenous fluids and insulin. Conclusion Clinicians should focus on close monitoring of diabetic patients with COVID-19, to prevent diabetic emergencies like DKA and HHS. It is important to aggressively manage these conditions for a favorable outcome.

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

“…In our review, males gender predominated development of DKA in SARS-CoV-2 patients, a finding suggested in most of the reports [ 11 – 13 , 15 – 17 , 19 , 20 , 23 , 25 , 26 , 31 , 33 , 36 , 37 , 39 , 47 , 50 , 52 , 55 – 58 , 60 – 64 , 69 , 74 , 75 ] and in contradiction with data from other reports suggesting an equal proportion of DKA cases in COVID-19 patients for both genders [ 30 , 34 , 38 , 49 ]. Lifestyle, body fat distribution, hormonal factors, susceptibility to glucotoxicity and lipotoxicity, and changes in insulin sensitivity have been described as potential factors of DKA and possible mechanisms of male predominance [ 88 ].…”

“…Among the included studies, 11 reported DKA and COVID-19 in children [ 8 , 11 , 22 , 30 , 34 , 44 , 45 , 56 , 61 , 66 , 72 ], 56 reported DKA and COVID-19 in adults [ 9 , 10 , 12 – 21 , 23 , 25 – 29 , 31 – 33 , 35 – 43 , 46 – 55 , 57 – 60 , 62 – 65 , 67 – 71 , 73 – 75 ], and only 1 study reported DKA and COVID-19 in both children and adults [ 24 ]. There were 54 case report [ 8 – 12 , 14 , 16 , 17 , 19 – 23 , 25 – 27 , 29 – 42 , 44 – 51 , 53 – 58 , 60 , 61 , 64 , 66 , 67 , 69 , 71 , 72 , 74 , 75 ], 10 case series [ 13 , 15 , 28 , 43 , 58 , 59 , 62 , 63 , 70 , 73 ...…”

“…The median or mean patient age ranged from < 1 years to 66 years across studies. There was an increased male predominance in DKA patients diagnosed with SARS-CoV-2 in most of the studies [n = 373, 58.4%] [ 9 – 13 , 15 – 17 , 19 , 20 , 23 , 25 , 26 , 31 – 33 , 36 , 37 , 39 , 45 , 47 , 50 – 52 , 55 – 58 , 60 – 64 , 67 – 69 , 74 , 75 ] and majority of the patients belonged to Hispanic (n = 156, 24.4%) and black (n = 98, 15.3%) ethnicity [ 14 – 16 , 18 , 19 , 21 , 24 , 27 , 28 , 44 – 46 , 54 , 57 , 58 , 62 , 63 , 65 , 68 , 75 ]. The median BMI for all included patients was 27.3 kg/m 2 [interquartile range (IQR) 24.8–30.6 kg/m 2 ].…”

“…The current meta-analysis is more comprehensive and included a total of 68 studies [ 8 – 75 ] including a total of 639 patients; whose details on final treatment outcome were available; in comparison to smaller sample size in previous meta-analyses [sample size: n = 45 and n = 21, respectively] [ 90 , 91 ]. The inclusion of 48 recently published studies [ 8 – 14 , 16 , 21 , 23 – 26 , 28 , 30 , 32 – 35 , 40 , 42 – 46 , 48 , 50 , 51 , 53 , 54 , 56 – 59 , 61 – 64 , 66 – 75 ] contributed to the refinement on evidence of the demographic, biochemical, and clinical characteristics; in addition to final therapy outcome in COVID-19 patients with DKA.…”

A Study on Neutrophil Lymphocyte Ratio in Covid 19 Patients in Tertiary Care Centre

“…Studies conducted by Zhuo F et al, have suggested that, Covid infection and its severity is higher amongst individuals with comorbidities, especially those with diabetes mellitus (12) .Diabetics reportedfor12%-22% of patients with COVID-19, higher thanthe incidence in non-diabetic people 9.3% (13) . Diabetes, itself being a chronic inflammatory disease, presents with significantly higher incidence of mortality and multiple organ damages.…”