A UK nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID-19
Field, Benjamin C T Ruan, Yue V�rnai, Kinga A Davies, Jim Ryder, Robert E J Gandhi, Rajiv Harris, Sophie Nagi, Dinesh Patel, Dipesh Kempegowda, Punith
Field, Benjamin C T
Ruan, Yue
V�rnai, Kinga A
Davies, Jim
Ryder, Robert E J
Gandhi, Rajiv
Harris, Sophie
Nagi, Dinesh
Patel, Dipesh
Kempegowda, Punith
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2023-04-04
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Abstract
Aims: To investigate characteristics of people hospitalized with coronavirus-disease-2019 (COVID-19) and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), and to identify risk factors for mortality and intensive care admission.
Materials and methods: Retrospective cohort study with anonymized data from the Association of British Clinical Diabetologists nationwide audit of hospital admissions with COVID-19 and diabetes, from start of pandemic to November 2021. The primary outcome was inpatient mortality. DKA and HHS were adjudicated against national criteria. Age-adjusted odds ratios were calculated using logistic regression.
Results: In total, 85 confirmed DKA cases, and 20 HHS, occurred among 4073 people (211 type 1 diabetes, 3748 type 2 diabetes, 114 unknown type) hospitalized with COVID-19. Mean (SD) age was 60 (18.2) years in DKA and 74 (11.8) years in HHS (p < .001). A higher proportion of patients with HHS than with DKA were of non-White ethnicity (71.4% vs 39.0% p = .038). Mortality in DKA was 36.8% (n = 57) and 3.8% (n = 26) in type 2 and type 1 diabetes respectively. Among people with type 2 diabetes and DKA, mortality was lower in insulin users compared with non-users [21.4% vs. 52.2%; age-adjusted odds ratio 0.13 (95% CI 0.03-0.60)]. Crude mortality was lower in DKA than HHS (25.9% vs. 65.0%, p = .001) and in statin users versus non-users (36.4% vs. 100%; p = .035) but these were not statistically significant after age adjustment.
Conclusions: Hospitalization with COVID-19 and adjudicated DKA is four times more common than HHS but both associate with substantial mortality. There is a strong association of previous insulin therapy with survival in type 2 diabetes-associated DKA.
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Field BCT, Ruan Y, Várnai KA, Davies J, Ryder REJ, Gandhi R, Harris S, Nagi D, Patel D, Kempegowda P, Wild SH, Wilmot EG, Khunti K, Rea R, Narendran P; ABCD COVID-19 Audit Group. A UK nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID-19. Diabetes Obes Metab. 2023 Apr 4. doi: 10.1111/dom.15076. Epub ahead of print. PMID: 37016487.
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