A UK nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID-19
Author
Field, Benjamin C TRuan, Yue
V�rnai, Kinga A
Davies, Jim
Ryder, Robert E J
Gandhi, Rajiv
Harris, Sophie
Nagi, Dinesh
Patel, Dipesh
Kempegowda, Punith
Wild, Sarah H
Wilmot, Emma G
Khunti, Kamlesh
Rea, Rustam
Narendran, Parth
ABCD COVID-19 Audit Group
Publication date
2023-04-04Subject
Endocrinology
Metadata
Show full item recordAbstract
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.Citation
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.Type
ArticleAdditional Links
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1463-1326PMID
37016487Journal
Diabetes, Obesity and MetabolismPublisher
Wileyae974a485f413a2113503eed53cd6c53
10.1111/dom.15076