ArticleJournal of diabetes investigation2026
COVID-19 and diabetic ketoacidosis: National outcomes, predictors, and resource utilization in the United States.
Article in Journal of diabetes investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe impact of COVID-19 infection on diabetic ketoacidosis (DKA) outcomes remains incompletely characterized at a national level.
methodsWe analyzed adult DKA hospitalizations in the United States from the 2020-2021 National Inpatient Sample. The primary outcome was in-hospital mortality; secondary outcomes included acute kidney injury (AKI), mechanical ventilation, sepsis, vasopressor use, length of stay (LOS), and hospitalization cost. Multivariable regression and propensity score matching adjusted for patient- and hospital-level variables.
resultsAmong 658,675 DKA hospitalizations, 69,005 (10.5%) involved COVID-19. Patients with COVID-19 were older and had a greater comorbidity burden. Crude in-hospital mortality was higher with COVID-19 (21.3% vs 3.4%, P < 0.001). After adjustment, COVID-19 was associated with over sixfold higher mortality (aOR 6.22; 95% CI: 5.85-6.62), increased risks of AKI (aOR 1.15), ventilation (aOR 3.91), sepsis (aOR 1.77), vasopressor use (aOR 2.33), longer LOS (+3.99 days), and higher costs (+$15,248; all P < 0.001). Propensity-matched analysis confirmed these findings. In subgroup analysis, type 1 diabetes was linked to higher mortality (aOR 2.12) vs type 2 diabetes. Predictors of mortality included age, comorbidity burden, hospital size, and Hispanic ethnicity; female sex was protective only in COVID-19 DKA.
conclusionsIn this national analysis, COVID-19 significantly worsened mortality, multiorgan failure, and healthcare utilization in DKA admissions. DKA with COVID-19 represents a high-acuity entity warranting early escalation and resource allocation.
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