key: cord-0945678-90z8dy4y authors: Muhammad, Asim; Hakim, Muhammad; Afaq, Saima; Khattak, Farhad Ali; Shakireen, Najmush; Jawad, Muhammad; Saeed, Rabia; Haq, Zia Ul title: Diabetic ketoacidosis amongst patients with COVID‐19: A retrospective chart review of 220 patients in Pakistan date: 2022-02-24 journal: Endocrinol Diabetes Metab DOI: 10.1002/edm2.331 sha: 392de364515618968285bf6a9da2a8cd13de143d doc_id: 945678 cord_uid: 90z8dy4y OBJECTIVES: To determine the frequency of diabetes mellitus and diabetic ketoacidosis and associated factors in COVID‐19‐positive patients. BACKGROUND: High mortality amongst SARS‐Cov2 patients may be attributed to diabetes and diabetic ketoacidosis. METHODS: A total of 220 COVID‐19 positive patients, hospitalized in North West General Hospital & Research Center, Peshawar, KP, Pakistan, from April to September 2020, were analysed using STATA 14. Patients with positive PCR were labelled as COVID‐19 positive and were included in the study. Patients with a clinical picture of COVID‐19 and negative PCR were excluded from the study. Those having ketonemia >0.6 and random blood glucose level >250mg/dl, while HCO3 (bicarbonate) ≤18, were labelled as diabetic ketoacidosis. The statistical significance level was set at p < .05. RESULTS: A total of 220 COVID‐19 patients were admitted; 166 (75.4%) were male and 54 (24.5%) were female. The mean age in years of the patients was 55.95 (SD13.9). About 57.7% of patients had diabetes mellitus, and 15 (6.8%) patients developed diabetic ketoacidosis. Amongst those with DKA, 5 patients died during hospital admission. The use of steroids was significantly higher (p < .001) in the DKA group compared with non‐DKA patients. Hypertension (103,46.8%) and fever (170,77.3%) were the most reported comorbidity and symptom respectively. CONCLUSION: The proportion of diabetes mellitus is high in patients with COVID‐19. Diabetic ketoacidosis is a frequent complication in this group associated with in‐hospital mortality. Steroid administration for COVID‐19 should be balanced with strict glycemic control to prevent diabetic ketoacidosis and increase hospital survival. Coronavirus disease 2019 (COVID- 19) has become a catastrophic pandemic affecting people throughout the world and severely disturbing public health security. 1, 2 Its pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the third identified human beta-coronavirus, which is reported to target pulmonary systems 3, 4 Clinical spectrums of COVID-19 vary from asymptomatic to lethal pneumonia. 5 Besides these, COVID-19 has unpredictable effects on many organs. However, data regarding the endocrine impact of COVID-19 are limited. Rubino et al 6 proposed that SARS-CoV-2 leads to ketosis-prone diabetes via binding to its cellular entry ACE-2 receptors, which are abundant in pancreatic beta cells and adipose tissue, leading to glucose metabolism abnormalities and pancreatic beta-cell destruction. This mechanism underlies the development of diabetes mellitus (DM) in SARS-CoV2 patients. 7 Moreover, SARS-CoV-2 may induce an autoimmune attack on the pancreatic islet cells mimicking the pathogenesis of insulin-dependent DM. 8 The elevated HbA1C and the presence of DM risk factors in several patients may indicate that the newly diagnosed DM is a result of metabolic disturbances from COVID-19 illnesses unmasking the existing DM 9 rather than causing the new onset of disease 10, 11 However, the unusual high incidences of diabetic ketoacidosis (DKA) in type 2 DM raise the issue of whether COVID-19 can further damage pancreatic islet cells leading to insulin deficiency states. 12, 13 The present study aimed to determine the frequency of DKA and diabetes mellitus in COVID-19 patients and compare the clinical characteristics and associated factors of patients with non-DKA to those with DKA. was obtained to access the data from the hospital server system and use it for the current research. All laboratory investigations were done during the patient admission in the hospital laboratory. Nasopharyngeal swabs were taken for confirmation of SARS COV-2 through PCR. Patients with positive PCR were labelled as COVID-19 positive and were included in the study. Clinically suspected COVID-19 patients with negative PCR while those who had positive PCR but refused in-hospital treatment were excluded. Patients with a history of diabetes, with a confirmed physician's diagnosis, or who were on a specific diet and/or were already taking oral hypoglycemic or insulin, were labelled as previously known diabetes, while patients with no history of diabetes before admission and had HbA1c of equal to or more than 6.5% done during this admission were labelled as previously unknown diabetes. Patients with all three of the following were labelled as diabetic ketoacidosis (DKA). Data were analysed using STATA 14. Continuous variables are presented as mean (SD) while categorical variables as percentages and numbers. Frequencies of demographic characteristics, symptoms and comorbidities were described and compared between the survivors and no survivors using the chi-squared and Fisher's exact test. The statistical significance level was set at p < .05 (two-sided). A total of 15 (6.8%) COVID-19 patients were diagnosed with DKA. Amongst these, 10 (66.7%) were males and 5 (33.3%) were females. Out of the 15 DKA patients, 9 were aged above 55 years while 6 were less than 55 years of age. The number of DKA patients who died and recovered was 5 (33.3%) and 10 (66.7%) respectively. Regarding the status of diabetes mellitus of DKA patients, 11(73.3%) had previously known diabetes and 4 (26.6%) had previously unknown diabetes. (Table 2) . Diabetic Ketoacidosis patients with hypertension was present The objective of our study was to determine the frequency of COVID-19 patients having DKA and compare the clinical characteristics and associated factors of patients with DKA to those without DKA. Our results show that most of the participants were males, and a major proportion was aged above 56 years while the mean length of the hospital was ~8 days. Amongst the total 220 COVID-19 patients, almost 6.82% was newly diagnosed, whereas almost 26.6% More research is necessary to investigate the causal relationship between diabetes, DKA and COVID-19. None. None to declare. The study was approved by the ethical committee of Northwest General Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan. (NWGH/2378). The data that support the findings of this study are available in the supplementary material of this article. 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