COVID, a “Deadly Determinant” for Patients with DM that Develop DKA and/or HHS

Patients with diabetes mellitus (DM) infected with COVID are at risk for developing severe complications including diabetic ketoacidosis (DKA) and/or hyperosmolar hyperglycemic state (HHS)1. They may have a more severe disease course and higher mortality compared to those without DM or hyperglycemia2. The Riverside University Health System Medical Center (RUHS-MC)-DKA Outcomes Group (RUDOG) initiated a study to determine causes and outcomes before and during the pandemic in patients hospitalized for DKA and/or HHS.

Methods:

RUHS-MC is a safety net hospital serving patients in Riverside County, CA and 13.2% within Riverside County having DM4. This was a retrospective cohort study reviewing medical records of non-pregnant adults age 18 or older admitted to the RUHS-MC for DKA and/or HHS from Mar 2020 to Feb 2021 (“pandemic”) compared to the 3 years before the pandemic (“pre-pandemic”). The descriptive statistics were used to determine the clinical characteristics of hospitalized adult patients with DKA and/or HHS. Cause of death was extracted from chart reviews. Categorical data were compared using Fisher's Exact Test. Numerical variables were assessed using Mann-Whitney Test.

Results:

From Mar 2020 to Feb 2021, 289,450 residents in Riverside County had COVID infection and 3,767 died3. There was an annual average of 285±51 of DKA and/or HHS patients admitted pre-pandemic versus 355 patients during pandemic. The average deaths per year pre-pandemic was 5±2.6, which significantly increased to 30 deaths during pandemic. Most of the deaths (24/30) were COVID infected. On average, the cases of deaths during pandemic were noted to have DM for a longer duration, and had longer length of stay (LOS). Sixty-three percent and 31% of patients had DKA and/or HHS due to infection during the pandemic and pre-pandemic, respectively. Respiratory failure was the cause of death in 46.7% and 23.1% of the deaths in pandemic and pre-pandemic, respectively.

Discussion/Conclusion:

In RUHS-MC, the mortality rate of DKA and/or HHS was significantly higher during the pandemic compared to the prior 3 years. Most of the deaths during the pandemic time had COVID infection, developed DKA and/or HHS due to an active infection, and found to have respiratory failure as the cause of death suggesting COVID infection is the major driving force for death in patients admitted with DKA and/or HHS. Moreover, the duration of DM and LOS were longer among deaths during pandemic, which are consistent with prior studies that DM is a major risk for COVID infection and severe disease.