Diabetic Ketoacidosis Rates Increased During COVID-19 Pandemic in Patients With Type 1 Diabetes

Diagnosis Diabetic Ketoacidosis dka and syringe.
A team of investigators analyzed trends in diabetic ketoacidosis occurrence during the COVID-19 pandemic.

Diabetic ketoacidosis (DKA) was found to occur more frequently in patients with type 1 diabetes (T1D) during COVID-19 surges in 2020 compared with the same periods in 2019, according to the results of a study published in the Journal of Clinical Endocrinology & Metabolism.

A retrospective cohort study conducted at 7 large US medical centers compared DKA events among children and adults with T1D during COVID-19 surge 1 (March through May 2020) and COVID-19 surge 2 (August through October 2020) with the same periods in 2019.

Data from 15,267 patients with T1D in 2019 (mean age, 37.7 years; 49.9% male) and from 15,176 patients with T1D in 2020 (mean age, 38.5 years; 52.1% male) were evaluated.

The proportion of patients who had DKA was higher in 2020 vs 2019 among patients aged 60 years and older (32.2% vs 29.4%, P =.02) and among patients with glycated hemoglobin (HbA1c) <7% (19.1% vs 16.4%, P =.008). The proportion of patients with DKA was lower in 2020 vs 2019 among patients who used a continuous glucose monitor (13.2% vs 15.0%, P <.001) or an insulin pump (8.0% vs 10.6%, P <.001).

Among all patients with T1D, a higher proportion had DKA during COVID-19 surge 1 or 2 in 2020 compared with the same periods in 2019 (surge 1: 7.1% vs 5.4%, P <.001; surge 2: 6.6% vs 5.7%, P =.001). A higher proportion of patients who had established T1D had DKA during COVID-19 surge 1 or 2 in 2020 compared with the same periods in 2019 (surge 1: 6.2% vs 4.7%, P <.001; surge 2: 5.6% vs 4.9%; P =.02).

A higher proportion of non-Hispanic Black patients had DKA in 2019 compared with non-Hispanic White patients (44.6% vs 16.0%; P < .001) and Hispanic patients (17.2%; P =.001), respectively, and this disparity continued in 2020 (48.6% vs 18.4% and 14.7%; P ≤.001).

The researchers noted that their findings may not be representative of all diabetes centers in the United States, and it is unlikely that all patients with DKA presented to their home diabetes centers for care. Also, data were submitted in monthly aggregates, and variation occurred regarding how data elements were tracked and tabulated at each institution.

“DKA frequency was highest by far among [non-Hispanic Blacks], both during the COVID-19 pandemic and prior,” stated the researchers. “More encouragingly, we provide evidence that DKA was less common among patients on [continuous glucose monitoring] or insulin pump during the first year of the COVID-19 pandemic. Further work is needed to improve strategies to prevent DKA in patients with T1D under pandemic conditions as well as postpandemic, especially among those most impacted by inequities in health care.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Lavik AR, Ebekozien O, Noor N, et al. Trends in type 1 diabetic ketoacidosis during COVID-19 surges at seven US centers: highest burden on non-Hispanic Blacks. J Clin Endocrinol Metab. Published online March 30, 2022. doi:10.1210/clinem/dgac158