A nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID‐19

Field, Benjamin C. T.; Ruan, Yue; Várnai, 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; Edwards, Amy; Gelding, Susan; Gunganah, Kirun; Aung, Pyei; Banerjee, Moulinath; Chakera, Ali; Rouse, Dominique; Ahmed, Syed Haris; Cheung, Ho Yee; Roberts, Hywel; Seal, Susan; Shah, Syed Saah; Hayat, Amir; Mohandas, Cynthia; Aung, Htet Htet; Chel, Su Khant; Lin, Nyan; Narula, Kavitia; Quadri, Furruq; Yin, Su Lei; Yin, Yin; Alkundi, Alamin; Musa, Abdelmajid; Birbeck, Emma; Bodmer, Charles; Bossman, Irene; Kumar, Sathis; Dashora, Umesh; Toubi, Elizabeth; Zafar, Mansoor; Patel, Vinod; Gopinath, Amitha; Allan, Belinda; Karim, Remat; Levy, Raphael; Aquino, Maia; Rahman, Ayesha; Harris, Sophie; Baxter, Susan; Adamus, Malgorzata; Baynes, Kevin; Sivappriyan, Siva; D’Costa, Ryan; Nagi, Dinesh; Parfitt, Vernon; Islam, Mazharul; Nasir, Sadia; Rea, Rustam...

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.

Citation

Field, B. C. T., Ruan, Y., Várnai, K. A., Davies, J., Ryder, R. E. J., Gandhi, R., Harris, S., Nagi, D., Patel, D., Kempegowda, P., Wild, S. H., Wilmot, E. G., Khunti, K., Rea, R., Narendran, P., Edwards, A., Gelding, S., Gunganah, K., Aung, P., Banerjee, M., …Williams, D. (2023). A nationwide study of adults admitted to hospital with diabetic ketoacidosis or hyperosmolar hyperglycaemic state and COVID‐19. Diabetes, Obesity and Metabolism, 25(7), 2012-2022. https://doi.org/10.1111/dom.15076

• Journal Article Type: Article
• Acceptance Date: Mar 31, 2023
• Online Publication Date: Apr 4, 2023
• Publication Date: 2023-07
• Deposit Date: Feb 14, 2024
• Publicly Available Date: Feb 16, 2024
• Journal: Diabetes, Obesity and Metabolism
• Print ISSN: 1462-8902
• Electronic ISSN: 1463-1326
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 7
• Pages: 2012-2022
• DOI: https://doi.org/10.1111/dom.15076
• Keywords: Endocrinology, Diabetes and Metabolism, Internal Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/19779619
• Publisher URL: https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.15076