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06-09-2021 | Diabetes | News | Article

Pandemic rise in DKA admissions conceals opposing trends

Author: Eleanor McDermid

medwireNews: Researchers find the increase in hospital admissions for diabetic ketoacidosis (DKA) in England during the COVID-19 pandemic was caused by additional admissions of people with new-onset or type 2 diabetes.

By contrast, there was a marked reduction in DKA admissions of people with type 1 diabetes relative to the equivalent time periods in previous years, they report in The Lancet Diabetes & Endocrinology.

The data comprised all emergency hospital admissions in England for DKA during the first wave of the pandemic (March 1 to June 30, 2020), the post-first wave period (July 1 to October 31, 2020), and the second wave as far as data were available (November 1, 2020 to February 28, 2021).

During these three periods there were 8553, 8729, and 10,235 DKA admissions, respectively, which represented significant 6%, 6%, and 7% increases over admissions in the equivalent periods between March 2017 and February 2020.

However, this overall rise concealed larger variations within different subcategories. People with type 1 diabetes accounted for approximately half of all DKA admissions in all three pandemic periods, yet these cases represented large reductions relative to the preceding 3 years, by 19%, 14%, and 25% in the first wave, post-first wave, and second wave, respectively.

“The traditional drivers of DKA in type 1 diabetes are insulin omission or concurrent illness, or both,” comment Jonathan Valabhji (NHS England and NHS Improvement, London, UK) and study co-authors.

“[O]ur findings therefore suggest that there were substantial modifications to these risk factors during both waves of the pandemic.”

By contrast, there were large rises in DKA admissions of people with type 2 diabetes, at 41%, 30%, and 50% during the first wave, post-first wave, and second wave, respectively, when compared with the equivalent periods in 2017–2020.

The researchers note that people with type 2 diabetes admitted with DKA during the pandemic were demographically similar to people known to be at risk for poor COVID-19 outcomes, saying: “Our findings suggest excess DKA in individuals at risk of severe COVID-19 and in whom DKA most likely developed during critical illness.”

While the proportion of people with a COVID-19 diagnosis was relatively low, it was significantly more common among people with type 2 diabetes than with type 1 or new-onset diabetes. The rates during the first wave, for example, were 23% versus 6–7%.

There was also a significant increase in DKA admissions among people with new-onset diabetes, at 57%, 56%, and 61% in the first wave, post-first wave, and second wave, respectively.

The study authors caution that they could not draw assumptions about the type of diabetes in this group, as all DKA admissions are treated with and discharged on insulin, with a diagnosis confirmed later.

“The excess of DKA admissions in people with newly diagnosed diabetes requires further study and must be interpreted in the context of overall diabetes incidence,” they conclude.

“The prompt recognition of new-onset diabetes and the features of those at risk of DKA in existing populations with diabetes are key to mitigating this excess of DKA in the context of the COVID-19 pandemic.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

6 September 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Lancet Diabetes Endocrinol 2021; doi:10.1016/S2213-8587(21)00208-4