COVID-19 Deaths Higher in People With Diabetic Ketoacidosis

Diagnosis Diabetic Ketoacidosis dka and syringe.
COVID-19 infection can be more severe in people with other medical conditions. Researchers investigated if diabetic ketoacidosis was one of them.

A retrospective cohort study, published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews, found that infection with COVID-19 increased the risk of developing diabetic ketoacidosis (DKA).

Patient records from 11 hospitals of New York City Health & Hospitals (NYCHHC) public health care system were retrospectively reviewed for this study. The medical records of patients (n=7692) admitted with COVID-19 between March and April 2020 were reviewed for DKA and mortality rates. Outcomes were compared with pre-COVID-19 patient (n=6938) trends in 2019.

The pandemic and prepandemic cohorts were aged median 62.73 (interquartile range [IQR], 62.37-63.09) and 59.40 (IQR, 58.95-59.85) years, 62.4% and 57.1% were men, 49% and 40% were Black, 38% and 28% were Hispanic, 72.56% and 67.55% had hypertension, and 60.51% and 52.61% had diabetes, respectively. Mortality rates during the COVID-19 pandemic period were 30.16% compared with 3.21% in the prepandemic period (P <.001).

There were 147 (3.14%) and 51 (0.74%) cases of DKA during the pandemic and pre-pandemic periods, respectively. The DKA patient population during the height of the COVID-19 pandemic was older (P =.01), had a higher BMI (P =.001), lower oxygen saturation (P =.003), higher potassium level (P <.001), and elevated blood urea nitrogen levels (P <.001). Higher potassium levels in people who had DKA during the pandemic, according to the researchers, were most likely related to more severe renal insufficiency in the same patients, when interpreted with their elevated blood urea nitrogen and creatinine levels.

Mortality rates associated with DKA were 46.3% during the COVID-19 pandemic in 2020, compared with 17.7% in 2019 (P <.001).

Increased risk for DKA-related mortality during the pandemic was found among patients with oxygen saturation <95% (odds ratio [OR], 9.27; 95% CI, 4.09-21.05; P <.001), systolic blood pressure <100 mmHg (OR, 9.98; 95% CI, 4.17-23.89; P <.001), blood urea nitrogen >20 mg/dl (OR, 2.53; 95% CI, 1.11-5.77; P =.040), and creatinine >0.9 mg/d (OR, 5.07; 95% CI, 1.40-18.39; P =.015).

The retrospective observational study compared 2 separate time periods, so causality directly related to COVID-19 infection could not be conclusively established, according to the researchers. They also noted the study was also limited because the patient records analyzed were only from admissions through the emergency department of  NYCHHC hospitals.

“Our study found it was not necessarily the patients with worse DKA that died, but patients with worse COVID-19,” the researchers concluded. “This was seen in higher respiratory rates, worse renal failure, and higher [Sequential Organ Failure Assessment] scores were associated with higher mortality rates,” the researchers concluded, adding the findings should help guide future care strategies.


Khan F, Paladino L, Sinert R. The impact of COVID-19 on diabetic ketoacidosis patients. Diabetes Metab Syndr. 2022;16(1):102389. doi:10.1016/j.dsx.2022.102389