Diabetic ketoacidosis and COVID-19: what have we learned so far?

Sá-Ferreira, Caio Oliveira de; Costa, Camila Heleno Macedo da; Guimarães, João Campos Wiltgen; Sampaio, Natascha Cristina Santos; Silva, Leticia de Moraes Lopes; Mascarenhas, Larissa Paula de; Rodrigues, Nicollas Garcia; Santos, Talita L.; Campos, Solange; Young, Esther Cytrynbaum

doi:10.1152/ajpendo.00244.2021

Cited by 34 publications

(32 citation statements)

References 53 publications

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“…CD4+ T lymphocytes are quickly activated into T helper-1 cells leading to the high secretion of inflammatory cytokines (IL-6) [11]. IL-6 is an important cytokine of hyper inflammation in COVID-19, it's already increased in patients with underlying type-1 diabetes mellitus and it triggers ketogenesis [11]. This case report shows the application of a local therapeutical protocol for COVID-19 and the management of DKA at the same time.…”

Section: Discussionmentioning

confidence: 92%

“…In addition, virus directly damages the cells, especially T-cell function which can be reduced. CD4+ T lymphocytes are quickly activated into T helper-1 cells leading to the high secretion of inflammatory cytokines (IL-6) [11]. IL-6 is an important cytokine of hyper inflammation in COVID-19, it's already increased in patients with underlying type-1 diabetes mellitus and it triggers ketogenesis [11].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of intravenous immunoglobulin in the treatment of a COVID-19 patient

et al. 2022

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Introduction. Diabetes mellitus patients represent vulnerable group of people who are prone to getting infected with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The virus has a high binding affinity to angiotensin-converting enzyme 2 receptor which allows efficient host cell entering, prolonged virus retention and possibility of insulin resistance and ketoacidosis development. Case outline. We describe a case of a 20-year-old patient with a past medical history of type-1 diabetes mellitus who presented with bilateral COVID-19 pneumonia. Initially treatment with polyvitamin therapy, corticosteroids, tocilizumab and convalescent plasma did not improve the patient condition, but might have led to the worsening of underlying disease, high blood glucose level and ketoacidosis. Patient developed a rapid progression of the disease and severe pneumonia that required intubation and mechanical ventilation. Intravenous immunoglobulin (IVIg) has been administrated in order to suppress a hyperactive immune response through its immunomodulatory effect. Forty-eight hours later respiratory gas exchange had been improved, almost complete regression of changes in the lungs have been seen, normalization of metabolic and gas exchange parameters have been detected. After 14 days in the hospital the patient was discharged home in good general condition. Conclusion. COVID-19 complicated by diabetes mellitus leads to a poor outcome of the disease, but antiviral and anti-inflammatory activity of IVIg suggests that they may be useful therapeutic agent and in the case of COVID-19. In the presented case, the application of IVIg very fast led to an improvement in the patient?s condition.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Efficacy of intravenous immunoglobulin in the treatment of a COVID-19 patient

et al. 2022

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“…Moreover, the increased prevalence of insulin-requiring hyperglycemia in patients with COVID-19 suggests that SARS-CoV-2 may trigger selective beta-cell inflammation [ 67 ], which could predispose to beta-cell autoimmunity and contribute to the complex pathogenesis of T1D [ 68 ]. On the other hand, in patients with established T1D, the low beta-cell secretory reserve may confer a high risk for DKA development under SARS-CoV-2 infection, potentially leading to higher disease morbidity and mortality [ 69 ].…”

Section: Discussionmentioning

confidence: 99%

BNT162b2 mRNA COVID-19 Vaccine Does Not Impact the Honeymoon Phase in Type 1 Diabetes: A Case Report

Infante

Fabbri

Padilla³

et al. 2022

Vaccines

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Type 1 diabetes (T1D), which is caused by the autoimmune destruction of insulin-secreting pancreatic beta cells, represents a high-risk category requiring COVID-19 vaccine prioritization. Although COVID-19 vaccination can lead to transient hyperglycemia (vaccination-induced hyperglycemia; ViHG), its influence on the course of the clinical remission phase of T1D (a.k.a. “honeymoon phase”) is currently unknown. Recently, there has been an increasing concern that COVID-19 vaccination may trigger autoimmune phenomena. We describe the case of a 24-year-old young Italian man with T1D who received two doses of the BNT162b2 mRNA (Pfizer-BioNTech) COVID-19 vaccine during a prolonged honeymoon phase. He experienced a transient impairment in glucose control (as evidenced by continuous glucose monitoring) that was not associated with substantial changes in stimulated C-peptide levels and islet autoantibody titers. Nonetheless, large prospective studies are needed to confirm the safety and the immunometabolic impact of the BNT162b2 vaccine in T1D patients during the honeymoon phase. Thus far, T1D patients who are going to receive COVID-19 vaccination should be warned about the possible occurrence of transient ViHG and should undergo strict postvaccination surveillance.

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“…New-onset hyperglycemia, worsening of pre-existing hyperglycemia, or even ketoacidosis has been seen in COVID-19 patients in an acute, inpatient setting [4]. The issue of hyperglycemia also has been seen to persist in some patient populations following both serious and mild cases of COVID-19 infection, indicating a possible long-term impact of the virus [5].…”

Section: Discussionmentioning

confidence: 99%

An Unanticipated Worsening of Glycemic Control Following a Mild COVID-19 Infection

Hardin¹,

Keller²,

Kennedy³

et al. 2022

Cureus

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We describe a case of acute-onset worsening of a patient's previously well-controlled type 2 diabetes mellitus (T2DM) following his recovery from a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 78-year-old male with a three-year medical history of well-controlled T2DM (controlled by diet and metformin) presented to the outpatient clinic to discuss his regularly scheduled six-month lab work. He mentioned having a mild coronavirus disease 2019 (COVID-19) infection lasting one week which required no medical treatment approximately two months before his current visit. His labs, taken one week prior to his current visit, were notable for fasting hyperglycemia, 301mg/dL, and an elevated hemoglobin A 1C (HbA 1C ), 11%. A fasting blood glucose level was recorded at his current in-office visit and was found to be 403mg/dL. These findings were not anticipated -our patient reported no change in his meals, medications, or exercise routines. The only notable change he reported between visits was his COVID-19 infection. This case report explores the link between this virus and our patient's exacerbation of his previously well-controlled T2DM. Whether it be through insulin resistance or deficiency (or another unknown mechanism), our patient's prior novel COVID-19 infection could potentially be associated with his unprecedented altered glucose metabolism.

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Diabetic ketoacidosis and COVID-19: what have we learned so far?

Cited by 34 publications

References 53 publications

Efficacy of intravenous immunoglobulin in the treatment of a COVID-19 patient

Efficacy of intravenous immunoglobulin in the treatment of a COVID-19 patient

BNT162b2 mRNA COVID-19 Vaccine Does Not Impact the Honeymoon Phase in Type 1 Diabetes: A Case Report

An Unanticipated Worsening of Glycemic Control Following a Mild COVID-19 Infection

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