Diabetic Ketoacidosis and COVID-19: Patient profiles from a regional emergency department in Johannesburg, South Africa

Abstract

Background: This study aimed to describe the clinical features and severity of illness in patients diagnosed with both coronavirus disease 2019 (COVID-19) and diabetic ketoacidosis (DKA) at a South African regional hospital.

Methods: This was a single centre, retrospective, observational study conducted at a regional hospital in Johannesburg, South Africa. Records of patients who presented to the emergency department (ED) between 01 April 2020 to 31 August 2021 and were diagnosed with DKA were reviewed. Both COVID-19 positive and negative patients were included.

Results: Of the 104 patients with DKA, 35 (33.7%) 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). Interventions included high-flow nasal cannula (1 patient), intubation (2 patients), and inotropic support (1 patient). Outcomes included one death (2.9%), one patient declining treatment, and one transfer. A statistically significant association was found between the COVID-19 positive group and increased age (p = 0.02), as well as a positive association with Type 2 Diabetes Mellitus (DMT2) (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 DMT2 was noted.

Contribution: Data on the burden of co-existing DKA and COVID-19 in South Africa remain limited. This study contributes by highlighting a lower observed mortality rate and underscores the need for further local research on this patient population.