Diabetic ketoacidosis precipitated by Coronavirus disease 2019 infection: Case series

Alsadhan, Ibrahim; Alruwashid, Shahad; Alhamad, Maram; Alajmi, Sarah; Alshehri, Sara; Alfadhli, Eman; Ekhzaimy, Aishah

doi:10.1016/j.curtheres.2020.100609

Cited by 29 publications

(30 citation statements)

References 14 publications

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“…Furthermore, obesity, hypertension, diabetic nephropathy, and cardiovascular disorders as common comorbidities of diabetes are connected to adverse outcomes of COVID-19 3 . Conversely, new-onset hyperglycemia, ketoacidosis, diabetes, and severe metabolic complications of pre-existing diabetes have been observed in patients suffering from COVID-19 5 – 11 . Besides single reports of COVID-19 potentially causing or triggering new-onset diabetes 8 , 10 , this phenomenon is currently analyzed in a newly established systematic registry ( http://covidiab.e-dendrite.com/ ) 11 .…”

Section: Introductionmentioning

confidence: 99%

Viral infiltration of pancreatic islets in patients with COVID-19

et al. 2021

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Metabolic diseases are associated with an increased risk of severe COVID-19 and conversely, new-onset hyperglycemia and complications of preexisting diabetes have been observed in COVID-19 patients. Here, we performed a comprehensive analysis of pancreatic autopsy tissue from COVID-19 patients using immunofluorescence, immunohistochemistry, RNA scope and electron microscopy and detected SARS-CoV-2 viral infiltration of beta-cells in all patients. Using SARS-CoV-2 pseudoviruses, we confirmed that isolated human islet cells are permissive to infection. In eleven COVID-19 patients, we examined the expression of ACE2, TMPRSS and other receptors and factors, such as DPP4, HMBG1 and NRP1, that might facilitate virus entry. Whereas 70% of the COVID-19 patients expressed ACE2 in the vasculature, only 30% displayed ACE2-expression in beta-cells. Even in the absence of manifest new-onset diabetes, necroptotic cell death, immune cell infiltration and SARS-CoV-2 viral infection of pancreatic beta-cells may contribute to varying degrees of metabolic dysregulation in patients with COVID-19.

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Section: Introductionmentioning

confidence: 99%

Viral infiltration of pancreatic islets in patients with COVID-19

et al. 2021

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“…There remains uncertainty surrounding the clinical presentation and management of DKA in those with COVID-19. Case series have demonstrated that COVID-19 can precipitate DKA in those with pre-existing and undiagnosed diabetes (11,12,13). It is clear larger-scale studies are needed to improve insight into the clinical characteristics and relationship between COVID-19 and DKA.…”

Section: Introductionmentioning

confidence: 99%

Effect of COVID-19 on the clinical course of diabetic ketoacidosis (DKA) in people with type 1 and type 2 diabetes

Kempegowda

Melson

Johnson

et al. 2021

Endocrine Connections

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Objective: COVID-19 in people with diabetes is associated with a disproportionately worse prognosis. DKA is an acute complication of diabetes with a mortality rate of approximately 0.67%. Little is known about the natural history of DKA in the presence of COVID-19. This study aimed to explore the effects of COVID-19 on presentation, clinical course and outcome in patients presenting with DKA. Design: Retrospective cohort study. Methods: All patients treated for DKA between 1 March 2020 and 30 May 2020 were included. Patients were categorised as COVID-positive or COVID-negative based on swab test. A pre-COVID group was established using data from 01 March 2019 to 30 May 2019 as external control. Data regarding demographics, diabetes type, pH, bicarbonate, lactate, glucose, DKA duration, complications and outcome were collected. Results: A total of 88 DKA episodes were included in this study. There was no significant difference in the severity or duration of DKA between the three groups. COVID-positive T1DM were more hyperglycaemic on admission compared to COVID-negative and pre-COVID patients. There was an over representation of T2DM in COVID-positive patients with DKA than in pre-COVID or COVID-negative groups. Conclusion: COVID-19 appears to influence the natural history of DKA differently in T1DM and T2DM. Patients with T1DM and COVID-19 presented with more hyperglycaemia (60mmol/l (35.9-60.0) vs. 31.4mmol/l (28.0-39.1) vs. 24mmol/l (20.2-33.75), respectively). Patients with T2DM were unusually presenting in DKA when infected with COVID-19 with greater ICU need and higher mortality rates. A collaborative, multi-centre study is needed to provide more definitive results.

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“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 pneumonia as well as extrapulmonary complication. There are a few cases of precipitation of new-onset diabetes and diabetes ketoacidosis associated with COVID-19 [3,4]. We present a case of a 44-year-old patient with COVID-19 and concomitant new onset of diabetes and severe diabetes ketoacidosis.…”

Section: Introductionmentioning

confidence: 94%

A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19

Patel¹,

Ayad²,

Rayad³

et al. 2021

Cureus

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Diabetic ketoacidosis (DKA) is a significant complication of poorly controlled diabetes. In diabetics, it typically occurs due to insulin deficiency resulting in lipolysis and subsequent ketone body formation and acidosis. The emergence of the COVID-19 infection has been associated with several complications, with the most prominent being pulmonary and cardiovascular-related. However, in some cases, patients with COVID-19 infection present with diabetic ketoacidosis. The pathophysiology of DKA in COVID-19 infection is different and currently not completely understood. The manifestation of DKA in COVID-19 patients is associated with increased severity of mortality and length of stay in these patients. Here, we describe a patient with no past medical history who presented with COVID-19 symptoms and was found to be in DKA. This case report highlights the possible underlying pathophysiology associated with this complication.

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Diabetic ketoacidosis precipitated by Coronavirus disease 2019 infection: Case series

Cited by 29 publications

References 14 publications

Viral infiltration of pancreatic islets in patients with COVID-19

Viral infiltration of pancreatic islets in patients with COVID-19

Effect of COVID-19 on the clinical course of diabetic ketoacidosis (DKA) in people with type 1 and type 2 diabetes

A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19

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