Incidence, characteristics, risk factors and outcomes of diabetic ketoacidosis in COVID‐19 patients: Comparison with influenza and pre‐pandemic data

Abstract

AbstractAimsThis study characterized incidence, patient profiles, risk factors and outcomes of in‐hospital diabetic ketoacidosis (DKA) in patients with COVID‐19 compared with influenza and pre‐pandemic data.MethodsThis study consisted of 13 383 hospitalized patients with COVID‐19 (March 2020‐July 2022), 19 165 hospitalized patients with influenza (January 2018‐July 2022) and 35 000 randomly sampled hospitalized pre‐pandemic patients (January 2017‐December 2019) in Montefiore Health System, Bronx, NY, USA. Primary outcomes were incidence of in‐hospital DKA, in‐hospital mortality, and insulin use at 3 and 6 months post‐infection. Risk factors for developing DKA were identified.ResultsThe overall incidence of DKA in patients with COVID‐19 and influenza, and pre‐pandemic were 2.1%, 1.4% and 0.5%, respectively (p < .05 pairwise). Patients with COVID‐19 with DKA had worse acute outcomes (p < .05) and higher incidence of new insulin treatment 3 and 6 months post‐infection compared with patients with influenza with DKA (p < .05). The incidence of DKA in patients with COVID‐19 was highest among patients with type 1 diabetes (12.8%), followed by patients with insulin‐dependent type 2 diabetes (T2D; 5.2%), non‐insulin dependent T2D (2.3%) and, lastly, patients without T2D (1.3%). Patients with COVID‐19 with DKA had worse disease severity and higher mortality [odds ratio = 6.178 (4.428‐8.590), p < .0001] compared with those without DKA. Type 1 diabetes, steroid therapy for COVID‐19, COVID‐19 status, black race and male gender were associated with increased risk of DKA.ConclusionsThe incidence of DKA was higher in COVID‐19 cohort compared to the influenza and pre‐pandemic cohort. Patients with COVID‐19 with DKA had worse outcomes compared with those without. Many COVID‐19 survivors who developed DKA during hospitalization became insulin dependent. Identification of risk factors for DKA and new insulin‐dependency could enable careful monitoring and timely intervention.