COVID-19 and diabetic ketoacidosis: A case series at an urban district hospital in South Africa

South African Family Practice

Field Value
Title COVID-19 and diabetic ketoacidosis: A case series at an urban district hospital in South Africa
Creator Dicks, Heather N. Naidoo, Keshena
Subject Family Medicine; Primary health care COVID-19; diabetic ketoacidosis; diabetes; district hospital; HbA1c
Description Background: Coronavirus disease 2019 (COVID-19) is associated with an increased prevalence and mortality from diabetic ketoacidosis (DKA) globally. With limited access to specialised care, most patients with DKA in South Africa are managed at district hospital level. This study describes the profile of patients admitted to a district hospital in South Africa with DKA and COVID-19 and examines associated risk factors encountered.Methods: This was a case series of all patients presenting to a district hospital with DKA and COVID-19 infection between July 2020 and July 2021. Data extracted included patients’ demographic profiles, biochemical results, comorbidities and clinical outcomes.Results: The median age of the 10 patients admitted during the study period was 39 years old (±12), six of whom were male. The hemoglobin A1c (HbA1c) values on admission ranged from 9.7 to 13.8. Five of the patients had pre-existing type 2 diabetes mellitus (DM). Four of the known DM patients were on metformin only, and one was on biphasic insulin. Three patients had other pre-existing comorbidities, two patients with hypertension and one with human immunodeficiency virus (HIV). Three patients demised, two of whom were hypoxic on admission.Conclusion: Diabetic ketoacidosis appears more commonly in COVID-19 infected patients with type 2 DM and at a young age. Suboptimal glycaemic control was associated with DKA, and hypoxia was a strong predictor for mortality. Treatment inertia was evident in the known DM group, who were on monotherapy despite persistent hyperglycaemia. Greater vigilance is required to detect ketosis in type 2 DM and intensify therapy to improve glycaemic control.
Publisher AOSIS
Date 2022-09-22
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Peer-reviewed Article Case series
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/safp.v64i1.5590
Source South African Family Practice; Vol 64, No 1 (2022): Part 4; 5 pages 2078-6204 2078-6190
Language eng
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Coverage Africa; South Africa; KwaZulu Natal, UmGungundlovu District July 2020 and July 2021 Age; Gender; Ethnicity; Comorbidities; Medication; Outcome
Rights Copyright (c) 2022 Heather N. Dicks, Keshena Naidoo