Incidence, characteristics, risk factors, and outcomes of diabetic ketoacidosis in COVID-19 patients without prior insulin dependence: comparison with influenza

Abstract

Abstract Whether SARS-CoV-2 infection triggers diabetic ketoacidosis (DKA) is unclear. This study characterized incidence, patient profiles, risk factors, and outcomes of in-hospital DKA in COVID-19 patients without prior insulin dependence and compared with influenza. This cohort consisted of 13,383 hospitalized COVID-19 patients (March 2020 to July 2022) and 19,165 hospitalized influenza patients (January 2018 to July 2022) in Bronx, NY. Patients with prior DKA and prior insulin use were excluded. Primary outcomes were in-hospital mortality and new-insulin use 3-month post-infection. The incidence of DKA in hospitalized COVID-19 patients was significantly higher than hospitalized influenza patients (1.4% vs. 0.8%, p < 0.05). COVID-19 patients with DKA were more likely to be intubated, receive steroid treatment, and die (mortality OR = 6.178, p < 0.05) than those without DKA. DKA patients without pre-existing diabetes were more likely to die than DKA patients with pre-existing diabetes (OR = 7.56, p < 0.05). Steroid use, pre-existing type-2 diabetes, and male sex were risk factors for DKA. Patients with DKA had a higher rate of insulin use 3 months post SARS-CoV-2 infection compared to those without DKA (8.2% vs. 1.6%, p < 0.05), suggesting SARS-CoV-2 infection could trigger new insulin dependence. Identification of risk factors for DKA and new insulin-dependency could enable careful monitoring and timely intervention.