Impacts of COVID-19 on Glycemia and Risk of Diabetic Ketoacidosis

Sharma, Anukriti; Misra‐Hebert, Anita D.; Mariam, Arshiya; Milinovich, Alex; Onuzuruike, Anthony; Koomson, Wilhemina; Kattan, Michael W.; Pantalone, Kevin M.; Rotroff, Daniel M.

doi:10.2337/db22-0264

Cited by 12 publications

(14 citation statements)

References 19 publications

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“…Sharma et al 30 tested whether COVID‐19 increased HbA1c, T2DM and DKA by comparing COVID‐positive patients to COVID‐negative controls. The positive group had a significantly greater HbA1c increase were 40% more likely to be diagnosed with T2DM.…”

Section: Resultsmentioning

confidence: 99%

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COVID‐19 associated ketosis and diabetic ketoacidosis: A rapid review

Alamuri

Mahesh

Dell’Aquila

et al. 2023

Diabetes Obesity Metabolism

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SARS-CoV-2 infection could disrupt the endocrine system directly or indirectly, which could result in endocrine dysfunction and glycaemic dysregulation, triggering transient or persistent diabetes mellitus. The literature on the complex relationship between COVID-19 and endocrine dysfunctions is still evolving and remains incompletely understood. Thus, we conducted a review on all literature to date involving COVID-19 associated ketosis or diabetic ketoacidosis (DKA). In total, 27 publications were included and analysed quantitatively and qualitatively. Studies included patients with DKA with existing or new onset diabetes. While the number of case and cohort studies was limited, DKA in the setting of COVID-19 seemed to increase risk of death, particularly in patients with new onset diabetes. Future studies with more specific variables and larger sample sizes are needed to draw better conclusions.

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Section: Resultsmentioning

confidence: 99%

“…Nine cohort studies were included in this review, seven of which are included in Table 3. Two studies 29,30 were not included in Table 3 as their results did not easily align with other studies. Ages ranged greatly from young adult to elderly across studies.…”

Section: Cohort Studiesmentioning

confidence: 99%

COVID‐19 associated ketosis and diabetic ketoacidosis: A rapid review

Alamuri

Mahesh

Dell’Aquila

et al. 2023

Diabetes Obesity Metabolism

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“…[1][2][3][4][5][6][7][8][9] A few reports also describe a link between new-onset diabetes and insulin-dependent diabetic ketoacidosis (DKA), [10][11][12][13][14][15][16] suggesting that SARS-CoV-2 infection could induce insulin dependence in addition to insulin resistance. Although the impact of COVID-19 on glycaemic dysfunction and risk of DKA have been described, 17 the incidence of DKA and associated outcomes are unknown. 16 In addition, the incidence of persistent insulin dependency after COVID-19-associated DKA, and the characteristics of those at risk for it, have not been well described.…”

Section: Introductionmentioning

confidence: 99%

Incidence, characteristics, risk factors and outcomes of diabetic ketoacidosis in COVID‐19 patients: Comparison with influenza and pre‐pandemic data

Dell’Aquila

Lee

Wang

et al. 2023

Diabetes Obesity Metabolism

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Aims This study characterized incidence, patient profiles, risk factors and outcomes of in‐hospital diabetic ketoacidosis (DKA) in patients with COVID‐19 compared with influenza and pre‐pandemic data. Methods This study consisted of 13 383 hospitalized patients with COVID‐19 (March 2020‐July 2022), 19 165 hospitalized patients with influenza (January 2018‐July 2022) and 35 000 randomly sampled hospitalized pre‐pandemic patients (January 2017‐December 2019) in Montefiore Health System, Bronx, NY, USA. Primary outcomes were incidence of in‐hospital DKA, in‐hospital mortality, and insulin use at 3 and 6 months post‐infection. Risk factors for developing DKA were identified. Results The overall incidence of DKA in patients with COVID‐19 and influenza, and pre‐pandemic were 2.1%, 1.4% and 0.5%, respectively (p < .05 pairwise). Patients with COVID‐19 with DKA had worse acute outcomes (p < .05) and higher incidence of new insulin treatment 3 and 6 months post‐infection compared with patients with influenza with DKA (p < .05). The incidence of DKA in patients with COVID‐19 was highest among patients with type 1 diabetes (12.8%), followed by patients with insulin‐dependent type 2 diabetes (T2D; 5.2%), non‐insulin dependent T2D (2.3%) and, lastly, patients without T2D (1.3%). Patients with COVID‐19 with DKA had worse disease severity and higher mortality [odds ratio = 6.178 (4.428‐8.590), p < .0001] compared with those without DKA. Type 1 diabetes, steroid therapy for COVID‐19, COVID‐19 status, black race and male gender were associated with increased risk of DKA. Conclusions The incidence of DKA was higher in COVID‐19 cohort compared to the influenza and pre‐pandemic cohort. Patients with COVID‐19 with DKA had worse outcomes compared with those without. Many COVID‐19 survivors who developed DKA during hospitalization became insulin dependent. Identification of risk factors for DKA and new insulin‐dependency could enable careful monitoring and timely intervention.

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“…[1][2][3][4] In addition, abnormalities in glycaemic control, insulin resistance and pancreatic islet function have been observed in patients with COVID-19 without a pre-existing history of diabetes, thus increasing the risk of developing Type 1 Diabetes (T1D), Type 2 Diabetes (T2D) or dysglycaemia. [5][6][7][8][9][10][11][12][13][14][15][16] Therefore, it is conceivable to hypothesise a bidirectional relationship between COVID-19 and diabetes. 17,18 Angiotensin I-converting enzyme type 2 (ACE2) is the canonical receptor for SARS-CoV-2.…”

Section: Introductionmentioning

confidence: 99%

Angiotensin I‐converting enzyme type 2 expression is increased in pancreatic islets of type 2 diabetic donors

Fignani

Pedace

Licata

et al. 2023

Diabetes Metabolism Res

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AimsAngiotensin I‐converting enzyme type 2 (ACE2), a pivotal SARS‐CoV‐2 receptor, has been shown to be expressed in multiple cells, including human pancreatic beta‐cells. A putative bidirectional relationship between SARS‐CoV‐2 infection and diabetes has been suggested, confirming the hypothesis that viral infection in beta‐cells may lead to new‐onset diabetes or worse glycometabolic control in diabetic patients. However, whether ACE2 expression levels are altered in beta‐cells of diabetic patients has not yet been investigated. Here, we aimed to elucidate the in situ expression pattern of ACE2 in Type 2 diabetes (T2D) with respect to non‐diabetic donors which may account for a higher susceptibility to SARS‐CoV‐2 infection in beta‐cells.Material and MethodsAngiotensin I‐converting enzyme type 2 immunofluorescence analysis using two antibodies alongside insulin staining was performed on formalin‐fixed paraffin embedded pancreatic sections obtained from n = 20 T2D and n = 20 non‐diabetic (ND) multiorgan donors. Intensity and colocalisation analyses were performed on a total of 1082 pancreatic islets. Macrophage detection was performed using anti‐CD68 immunohistochemistry on serial sections from the same donors.ResultsUsing two different antibodies, ACE2 expression was confirmed in beta‐cells and in pancreas microvasculature. Angiotensin I‐converting enzyme type 2 expression was increased in pancreatic islets of T2D donors in comparison to ND controls alongside with a higher colocalisation rate between ACE2 and insulin using both anti‐ACE2 antibodies. CD68+ cells tended to be increased in T2D pancreata, in line with higher ACE2 expression observed in serial sections.ConclusionsHigher ACE2 expression in T2D islets might increase their susceptibility to SARS‐CoV‐2 infection during COVID‐19 in T2D patients, thus worsening glycometabolic outcomes and disease severity.

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Impacts of COVID-19 on Glycemia and Risk of Diabetic Ketoacidosis

Cited by 12 publications

References 19 publications

COVID‐19 associated ketosis and diabetic ketoacidosis: A rapid review

COVID‐19 associated ketosis and diabetic ketoacidosis: A rapid review

Incidence, characteristics, risk factors and outcomes of diabetic ketoacidosis in COVID‐19 patients: Comparison with influenza and pre‐pandemic data

Angiotensin I‐converting enzyme type 2 expression is increased in pancreatic islets of type 2 diabetic donors

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