Background: Diabetic ketoacidosis (DKA) as an acute complication of diabetes mellitus is a life threatening medical emergency causing mortality and morbidity in patients. The aim of the study was to find out DKA prevalence and existing clinical presentation in diabetic-covid comorbidity.
Materials and Methods: The retrospective cross sectional study included 791 both male and female diabetic patients with a confirmed diagnosis of covid 19 based on purposive sampling for a period of one year from Aug 2021 to Aug 2022 from two centers (Corona Center and Nangarhar Regional Hospital) in Nangarhar, Afghanistan.
Findings: The study included 300 (37.9%) male and 491 (62.1%) female patients, 45 (5.7%) Type 1, 746 (94.3%) Type 2 diabetic patients, 511 (64.6%) old diabetes, and 280 (35.4%) new onset diabetes patients. Mean age at the study was 58.7±13, BMI was31.2±4, Systolic BP128.3±24.4, oxygen was 79.1±15.4, glycaemia was 297.5±8, and mean hospital stay was 8.8±8.1 days. In fact, 149 out of 791 patients (19%) had diabetic ketoacidosis (DKA) of which 140 patients out of 149 (93.96%) were hyperglycemic and 9 out of 149 patients (6%) were euglycemic DKA. Furthermore, DKA was more prevalent in males 58.4% vs 41.6% in females, young age (20-39 years) 31.2%, Type 1 diabetes 33.3% vs 21.9% type 2 diabetes, and old diabetes 19.5% vs 17.6% new onset diabetes. Moreover, clinical presentation included dyspnea 143 (96%), abdominal pain 124 (83.2%), nausea/vomiting 121 (81.2%), tachycardia 105 (70.5%), polydipsia of diabetic classic symptoms 70 (47%), and crepitation in chest auscultation though not significant 77 (51.7%). Pneumonia 92 (61.7%), and ARDS 54 (36.2%) were respectively the most prevalent clinical and X-ray findings in DKA patients. In addition, hospitalization duration was comparatively higher for females (10 vs 9), T2DM (10 vs 6), and new onset DM (14 vs 7) and it increased with advancing age (most for patients of ≥ 80 years) in DKA. Death and referral measures were significantly different across DKA positive and DKA negative patients i.e. 37.6% vs 14.8% and 16.1% vs 8.1% respectively. While, discharge status with home rest was more prevalent in DKA negative patients i.e. 46.3% vs 77.1%.
Conclusion: We concluded that DKA prevalence has increased almost two fold in diabetic patients suffering from corona virus affecting in-hospital mortality, hospital stay, morbidity and the preexisting clinical picture. In fact, obesity, hypertension, young age and male gender were significant factors contributing to the prevalence. In addition, mortality and referral rates to specialty specific centers were significantly higher in DKA positive patients with the aforementioned factors being the leading contributors.
KeywordsDiabetes, Diabetic Ketoacidosis, DKA, Covid 19, Afghanistan
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