Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Papadopoulos, Vassilios; Koutroulos, Marios-Vasileios; Zikoudi, Dimitra-Georgia; Bakola, Stefania-Aspasia; Avramidou, Peny; Touzlatzi, Ntilara; Filippou, Dimitrios

doi:10.1007/s13340-021-00502-9

Cited by 16 publications

(16 citation statements)

References 58 publications

(75 reference statements)

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“…A comparison of the current results with findings from previous studies can offer some validation of the findings of this present meta-analysis and identify methodological differences in their approaches. Regarding the mortality rate in patients who developed DKA during SARS-CoV-2 infection, we report an overall similar and slightly lower death rate [25.9%] compared to the previous two systematic meta-analyses [28.9 and 29%, respectively] [ 90 , 91 ]. The current meta-analysis is more comprehensive and included a total of 68 studies [ 8 – 75 ] including a total of 639 patients; whose details on final treatment outcome were available; in comparison to smaller sample size in previous meta-analyses [sample size: n = 45 and n = 21, respectively] [ 90 , 91 ].…”

Section: Discussionsupporting

confidence: 73%

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Alhumaid

Mutair

Alawi

et al. 2021

Diabetol Metab Syndr

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Background One possible reason for increased mortality due to SARS-CoV-2 in patients with diabetes is from the complication of diabetic ketoacidosis (DKA). Objectives To re-evaluate the association of SARS-CoV-2 and development of DKA and analyse the demographic and biochemical parameters and the clinical outcomes in COVID-19 patients with DKA. Design A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. Methods Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature) were searched from 1 December 2019 to 30 June 2021 in the English language using the following keywords alone or in combination: COVID-19 OR SARS-CoV-2 AND diabetic ketoacidosis OR DKA OR ketosis OR ketonemia OR hyperglycaemic emergency OR hyperglycaemic crisis. We included studies in adults and children of all ages in all healthcare settings. Binary logistic regression model was used to explore the effect of various demographic and biochemical parameters variables on patient’s final treatment outcome (survival or death). Results Of the 484 papers that were identified, 68 articles were included in the systematic review and meta-analysis (54 case report, 10 case series, and 4 cohort studies). Studies involving 639 DKA patients with confirmed SARS-CoV-2 [46 (7.2%) were children and 334 (52.3%) were adults] were analyzed. The median or mean patient age ranged from < 1 years to 66 years across studies. Most of the patients (n = 309, 48.3%) had pre-existing type 2 diabetes mellitus. The majority of the patients were male (n = 373, 58.4%) and belonged to Hispanic (n = 156, 24.4%) and black (n = 98, 15.3%) ethnicity. The median random blood glucose level, HbA1c, pH, bicarbonate, and anion gap in all included patients at presentation were 507 mg/dl [IQR 399–638 mg/dl], 11.4% [IQR 9.9–13.5%], 7.16 [IQR 7.00–7.22], 10 mmol/l [IQR 6.9–13 mmol/l], and 24.5 mEq/l [18–29.2 mEq/l]; respectively. Mortality rate was [63/243, 25.9%], with a majority of death in patients of Hispanic ethnicity (n = 17, 27%; p = 0.001). The odd ratios of death were significantly high in patients with pre-existing diabetes mellitus type 2 [OR 5.24, 95% CI 2.07–15.19; p = 0.001], old age (≥ 60 years) [OR 3.29, 95% CI 1.38–7.91; p = 0.007], and male gender [OR 2.61, 95% CI 1.37–5.17; p = 0.004] compared to those who survived. Conclusion DKA is not uncommon in SARS-CoV-2 patients with diabetes mellitus and results in a mortality rate of 25.9%. Mortality key determinants in DKA patients with SARS-CoV-2 infection are individuals with pre-existing diabetes mellitus type 2, older age [≥ 60 years old], male gender, BMI ≥ 30, blood glucose level > 1000 mg/dl, and anion gap ≥ 30 mEq/l.

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Section: Discussionsupporting

confidence: 73%

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Alhumaid

Mutair

Alawi

et al. 2021

Diabetol Metab Syndr

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“…24 A meta-analysis revealed that hyperglycaemic crisis is related with a high mortality. 25 were risk factors for lethality. 13 They reported that early-onset diabetes conferred an increased risk of hospitalization and a higher risk of mortality in younger patients, which was similar to older patients with comorbidities and only exceeded by older patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, hyperglycaemic crisis, which includes diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar syndrome (HHS) and combined syndrome of DKA and HHS (DKA/HHS), has also been reported in patients with COVID 24 . A meta‐analysis revealed that hyperglycaemic crisis is related with a high mortality 25 . In that study, patients with COVID‐19 and DKA had a mortality rate of 28.9% (95%CI 13.4%–47.5%), but when there was mixed DKA/HHS, mortality reached 31.5% (95%CI 1.2%–78.0%).…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 in a country with a very high prevalence of diabetes: The impact of admission hyperglycaemia on mortality

Martínez-Murillo

Peñafiel

Basurto

et al. 2021

Endocrino Diabet & Metabol

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“…Notably, reducing high admission glucose to 141–180 mg/dL (7.8–10 mmol/L) by day 2–3 was shown to significantly reduce the risk of mortality [ 45 ]. The impact of concurrent COVID with DKA and hyperglycaemic hyperosmolar syndrome (HSS) on post-admission outcomes [ 46 ] also argues for the application of immediate telemonitoring and glucose-lowering treatment following admission. Given that regular glucose monitoring using standard point-of-care testing exposes hospital teams to risk of COVID infection, the importance of telemonitoring that aids anti-glycaemic therapy whilst reducing frequent patient contact is strongly indicated.…”

Section: Hyperglycaemia Is a Significant Risk Factor For Covid Infection Hospitalization And Deathmentioning

confidence: 99%

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

et al. 2021

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People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

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Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Cited by 16 publications

References 58 publications

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

COVID‐19 in a country with a very high prevalence of diabetes: The impact of admission hyperglycaemia on mortality

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

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