Unmasking the escalation: a comparative analysis of diabetic ketoacidosis severity before and during the COVID-19 pandemic in a Tunisian pioneer study

Expert Rev Endocrinol Metab. 2024 Jul;19(4):393-398. doi: 10.1080/17446651.2024.2353723. Epub 2024 May 16.

Abstract

Background: The severity of diabetic ketoacidosis (DKA) at diagnosis increased during the global COVID-19 pandemic. This study aimed to analyze the impact of the pandemic on the clinical and biological severity of DKA in patients with new-onset diabetes mellitus (DM) in Tunisia.

Research design and methods: The study included patients hospitalized for new-onset DKA 2 years prior and 2 years during the COVID-19 pandemic. Data was collected retrospectively, and DKA severity was classified based on biological parameters like potential of hydrogen (pH) and HCO3-.

Results: The results showed that DKA was more severe during COVID-19, as evidenced by lower potential of hydrogen (pH) (p = 0.006), and serum bicarbonate (HCO3-) levels (p = 0,005). Despite the higher severity of DKA was higher during COVID-19, intensive care unit hospitalizations remained equivalent (p = 0.359). The prevalence of hyponatremia was also higher during COVID-19 (p = 0.024).

Conclusion: The findings suggest that delayed diagnosis and COVID-19 May contribute to the increased severity of DKA and electrolyte imbalance during the pandemic. Further research is needed to better understand the underlying mechanisms and develop appropriate strategies to address this issue.

Keywords: COVID-19; Diabetic ketoacidosis; diabetes mellitus; pandemic; severity.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Bicarbonates / blood
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • Diabetic Ketoacidosis* / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Retrospective Studies
  • SARS-CoV-2
  • Severity of Illness Index*
  • Tunisia / epidemiology

Substances

  • Bicarbonates