ArticleDiabetology & metabolic syndrome2021
Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis.
Article in Diabetology & metabolic syndrome, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 17 citations in OpenAlex.
- Diabetic ketoacidosis after COVID-19 infection in newly diagnosed patients with diabetes in the Middle East and African countries: A systematic review and meta-analysis.Journal of family medicine and primary care · 2026Review
- Endocrine Disorders and COVID-19 Severity in Pediatric Populations: A Systematic Review.Cureus · 2025Review
- Subacute Thyroiditis Due to COVID-19 Vaccine.Journal of community hospital internal medicine perspectives · 2024Article
- Impact of diabetic ketoacidosis on outcomes in hospitalized diabetic patients withProceedings (Baylor University. Medical Center) · 2024Article
- Comorbidities of COVID-19 Patients.Medicina (Kaunas, Lithuania) · 2023Review
- Comparison of Diabetic Ketoacidosis Characteristics During- and Before the COVID-19 Pandemic.International journal of endocrinology and metabolism · 2023Article
- Risks associated with acute pancreatitis (AP) with diabetic ketoacidosis (DKA) in COVID-19 patients: a literature review.Journal of diabetes and metabolic disorders · 2023Review
- The Effects of COVID-19 Pandemic and Lockdown on Pediatric Nutritional and Metabolic Diseases: A Narrative Review.Nutrients · 2022Review
- The Role of Diabetes and Hyperglycemia on COVID-19 Infection Course-A Narrative Review.Frontiers in clinical diabetes and healthcare · 2022Review
- Relationship between cytokine release and stress hyperglycemia in patients hospitalized with COVID-19 infection.Frontiers in medicine · 2022Article
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Authors and funding
16 authors at 10 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOne possible reason for increased mortality due to SARS-CoV-2 in patients with diabetes is from the complication of diabetic ketoacidosis (DKA).
objectivesTo 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.
designA systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed.
methodsElectronic 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).
resultsOf 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.
conclusionDKA 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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