(HealthDay News) — Patients with diabetic ketoacidosis (DKA) with COVID-19 have a much higher rate of mortality than patients without COVID-19, according to a research letter published online in JAMA Network Open.

Francisco J. Pasquel, MD, from the Emory University School of Medicine in Atlanta, and colleagues used individual-level inpatient data from 175 US hospitals (17 states; Feb. 1 to Sept. 15, 2020) to examine severity markers of DKA, insulin requirements, complications, and in-hospital case fatality in 5029 patients treated with the same computerized continuous insulin infusion (CII) algorithm with and without COVID-19.

The researchers found that 4% of patients (210 patients) were positive for COVID-19. Those with COVID-19 were older and had a higher body mass index compared with patients without COVID-19. Older patients with COVID-19 (>65 years) were more likely to have cardiovascular disease and diabetes complications than younger patients with COVID-19 (<45 years). Higher insulin requirements and a prolonged duration of CII with a longer time to resolution of DKA were seen among patients with COVID-19. Five percent of patients without COVID-19 died in the hospital versus 30% among those with COVID-19. Acute kidney injury was more frequent in patients with COVID-19 versus those without (30 versus 10%).

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“These findings are worrisome and warrant further investigation,” the authors write.

Two authors disclosed financial ties to the pharmaceutical industry, and several reported working at an insulin management software company.


Pasquel FJ, Messler J, Booth R, et al. Characteristics of and mortality associated with diabetic ketoacidosis among US patients hospitalized with or without COVID-19. JAMA Netw Open. 2021;4(3):e211091. doi:10.1001/jamanetworkopen.2021.1091