Co-existing Diabetic Ketoacidosis and COVID-19 A profile of patients presenting to a regional Emergency Department during the COVID-19 pandemic in Johannesburg, South Africa

Abstract

Background: This study aimed to describe the clinical features and severity of illness in patients diagnosed with both SARS-CoV-2 (COVID-19) and Diabetic Ketoacidosis (DKA) at a South African regional hospital. Methods: This was a single centre, retrospective, observational study in a regional hospital in Johannesburg, South Africa. Files from patients who presented to the Emergency Department (ED) between the period 1 April 2020 to 31 August 2021 and diagnosed with DKA were identified from registers. Patients who tested both positive and negative for COVID-19 were included in the study. Results: Of the 104 DKA patients identified, 35 (33.65%) tested positive for COVID-19. Among the COVID-19 positive group, two required ICU admission and two were admitted to the High Care Unit (HCU). Medical interventions included high-flow nasal cannula (1 patient), intubation (2 patients) and inotropic support (1 patient). Outcomes included one death (2.86%), one patient declining treatment and one transfer. There was a statistically significant association with increased age in the COVID-19 positive cohort (p=0.02) and positive association observed between the COVID-19 positive cohort and DM Type 2 (p=0.03). Conclusion: This retrospective study demonstrated that patients with COVID-19 and DKA had a lower mortality rate than previously described. In patients with both COVID-19 and DKA, a significant association with advanced age and Type 2 Diabetes Mellitus was noted. Keywords: diabetic ketoacidosis; COVID-19 Contribution: There is a paucity of data on co-existing DKA and COVID-19’s burden of disease on the health care system. This research noted a significant lower mortality rate in patients with COVID-19 and DKA than previously published.