Increased Frequency of Diabetic Ketoacidosis: The Link With COVID-19 Pandemic

Abstract

AimsDiabetic ketoacidosis is the most severe metabolic derangement due to prolonged insulin deficiency as in type 1 diabetes. Diabetic ketoacidosis, a life-threatening condition, is often diagnosed late. A timely diagnosis is mandatory to prevent its consequences, mainly neurological. The COVID-19 pandemic and lockdown have reduced the availability of medical care and access to hospitals. The aim of our retrospective study was to compare the frequency of ketoacidosis at the diagnosis of type 1 diabetes between the lockdown-post lockdown period and the previous two calendar years, in order to evaluate the impact of the COVID-19 pandemic.Patients and MethodsWe retrospectively assessed the clinical and metabolic data at the diagnosis of type 1 diabetes in children in the Liguria Region during 3 different time periods: calendar year 2018 (Period A), calendar year 2019 until February 23,2020 (Period B) and from February 24, 2020 onwards to March 31, 2021 (Period C).ResultsWe analyzed 99 patients with newly-diagnosed T1DM from 01/01/2018 to 31/03/2021. Briefly, a younger age at diagnosis of T1DM was observed in Period 2 compared to Period 1 (p = 0.03). The frequency of DKA at clinical onset of T1DM was similar in Period A (32.3%) and Period B (37.5%), while it significantly increased in Period C (61.1%) compared to Period B (37.5%) (p = 0.03). PH values were similar in Period A (7.29 ± 0.14) and Period B (7.27 ± 0.17), while they were significantly lower in Period C (7.21 ± 0.17) compared to Period B (p = 0.04).ConclusionsAn increase in the frequency of diabetic ketoacidosis has been documented in newly diagnosed pediatric patients in the Liguria Region during and after the lockdown period compared to previous calendar years. This increase could have been caused by the delay in diagnosis following the restrictions imposed by the lockdown with consequently reduced access to health care facilities. More information on the risks of ketoacidosis is desirable by means of social and medical awareness campaigns.

A Comprehensive Review of COVID-19–Associated Endocrine Manifestations

“…23 Because of the autoimmune nature of type 1 DM, diagnosis is confirmed by the positive results of several antibodies, including glutamic acid decarboxylase, insulin antibody, zinc transporter 8, and antityrosine phosphatase 2. 24 Worldwide criteria indicate that type 2 DM is diagnosed using fasting glucose, a 2-hour postoral glucose tolerance test, or hemoglobin A1c. 25 Several drugs have been reported to be safe in diabetic patients with concurrent COVID-19 disease.…”

Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review

“…Data about the prevalence of diabetic ketoacidosis (DKA) are much more concordant in the literature. Several cohort studies [ 91 , 93 , 98 , 102 , 106 , 123 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 ] and two meta-analyses [ 114 , 164 ] report increases in DKA frequency and DKA severity at diagnosis among newly diagnosed T1D patients. A multicenter study, involving 13 national diabetes registries (Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, the USA (Colorado), and Wales) compared the observed DKA prevalence in children and adolescents in 2020 and 2021 to predictions based on trends over the prepandemic years 2006–2019.…”

Diabetes mellitus y COVID-19, ¿una relación bidireccional?

“…Existen datos que demuestran que la cetoacidosis diabética (CAD) grave puede ser desencadenada por SARS-CoV-2 en pacientes con diabetes mellitus preexistente o de nueva aparición (33). Al comparar información previa al 2018 con la reportada después de marzo de 2021, se describe un aumento en la frecuencia de CAD de un 32,3 % contra un 61,1 % (34). Además, otros autores retratan un riesgo más alto de CAD (35 %) y cetoacidosis grave (76 %), comparado con el grupo previo a la pandemia (35).…”