Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 23;12(4):445-459.
doi: 10.1007/s13340-021-00502-9. eCollection 2021 Oct.

Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Vasileios P Papadopoulos  1   2   3 , Marios-Vasileios Koutroulos  1 , Dimitra-Georgia Zikoudi  1 , Stefania-Aspasia Bakola  1 , Peny Avramidou  1 , Ntilara Touzlatzi  1 , Dimitrios K Filippou  4
Affiliations

Diabetes-related acute metabolic emergencies in COVID-19 patients: a systematic review and meta-analysis

Vasileios P Papadopoulos et al. Diabetol Int. .

Abstract

Aims: COVID-19 is associated with diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and euglycaemic DKA (EDKA); however, evidence regarding parameters affecting outcome and mortality rates is scarce.

Methods: A systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 2020 to 7 January 2021 to identify all studies describing clinical profile, outcome and mortality rates regarding DKA, HHS, DKA/HHS and EDKA cases in COVID-19 patients. The appropriate Joanna Briggs Institute tools were used for quality assessment; quality of evidence was approached using GRADE. Univariate and multivariate analyses were used to assess correlations between clinical characteristics and outcome based on case reports. Combined mortality rates (CMR) were estimated from data reported in case report series, cross-sectional studies, and meta-analyses. The protocol was submitted to PROSPERO (ID: 229356/230737).

Results: From 312 identified publications, 44 were qualitatively and quantitatively analyzed. Critical COVID-19 necessitating ICU (P = 3 × 10-8), DKA/HHS presence (P = 0.021), and AKI (P = 0.037) were independently correlated with death. Increased COVID-19 severity (P = 0.003), elevated lactates (P < 0.001), augmented anion gap (P < 0.001), and AKI (P = 0.002) were associated with DKA/HHS. SGLT-2i were linked with EDKA (P = 0.004) and negatively associated with AKI (P = 0.023). CMR was 27.1% (95% CI 11.2-46.9%) with considerable heterogeneity (I 2 = 67%).

Conclusion: Acute diabetes-related metabolic emergencies in COVID-19 patients lead to increased mortality; key determinants are critical COVID-19 illness, coexistence of DKA/HHS and AKI. Previous SGLT-2i treatment, though associated with EDKA, might preserve renal function in COVID-19 patients.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-021-00502-9.

Keywords: Acute kidney injury; COVID-19; Diabetes complications; Diabetic ketoacidosis; Euglycaemic diabetic ketoacidosis; Hyperosmolar hyperglycemic state.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestAuthor VP, Author M-VK, Author D-GZ, Author S-AB, Author PA, Author NT, and Author DF declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
“Case reports meta-analysis”: Study flow diagram
Fig. 2
Fig. 2
“Case reports meta-analysis”: Forest plot depicting various patients’ characteristics odds ratios OR for death
Fig. 3
Fig. 3
“Case reports meta-analysis”: Ridge paths as derived from optimal scaling regularization process for the most parsimonious multivariate model
Fig. 4
Fig. 4
“Mortality rate meta-analysis”: Study flow diagram
Fig. 5
Fig. 5
“Mortality rate meta-analysis”: Forest plot depicting combined mortality rate from diabetes-associated acute metabolic emergencies in COVID-19 patients
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. - PMC - PubMed
    1. Ma WX, Ran XW. The management of blood glucose should be emphasized in the treatment of COVID-19. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020;51(2):146–150. - PubMed
    1. Kuchay MS, Reddy PK, Gagneja S, et al. Short term follow-up of patients presenting with acute onset diabetes and diabetic ketoacidosis during an episode of COVID-19. Diabetes Metab Syndr. 2020;14(6):2039–2041. - PMC - PubMed
    1. Gregory JM, Slaughter JC, Duffus SH, et al. COVID-19 severity is tripled in the diabetes community: a prospective analysis of the pandemic's impact in type 1 and type 2 diabetes. Diabetes Care. 2021;44(2):526–532. - PMC - PubMed
    1. McGurnaghan SJ, Weir A, Bishop J, et al.; Public Health Scotland COVID-19 Health Protection Study Group; Scottish Diabetes Research Network Epidemiology Group. Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland. Lancet Diabetes Endocrinol. 2020. 8587(20)30405–8. - PubMed

LinkOut - more resources