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1.
J Microbiol Immunol Infect ; 55(2): 183-190, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1882247

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly become a global threaten since its emergence in the end of 2019. Moreover, SARS-CoV-2 infection could also present with co-infection or secondary infection by other virus, bacteria, or fungi. Among them, mucormycosis is a rare but aggressive fungal disease and it mainly affects patients particularly with poorly controlled diabetes mellitus with diabetic ketoacidosis (DKA). We here did a comprehensive review of literature reporting COVID-19 associated with mucormycosis (CAM) cases, which have been reported worldwide. The prevalence is higher in India, Iran, and Egypt than other countries, particularly highest in the states of Gujarat and Maharashtra in India. Poor diabetic control and the administration of systemic corticosteroids are the common precipitating factors causing mucormycosis in the severe and critical COVID-19 patients. In addition, COVID-19 itself may affect the immune system resulting in vulnerability of the patients to mucormycosis. Appropriate treatments of CAM include strict glycemic control, extensive surgical debridement, and antifungal therapy with amphotericin B formulations.


Subject(s)
COVID-19 , Coinfection , Diabetic Ketoacidosis , Mucormycosis , Antifungal Agents/therapeutic use , COVID-19/complications , Coinfection/drug therapy , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/epidemiology , Humans , India/epidemiology , Mucormycosis/drug therapy , Mucormycosis/epidemiology , SARS-CoV-2
3.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801631

ABSTRACT

Mucormycosis (Zygomycosis) is a rare and lethal invasive fungal infection, often acute and extremely severe caused by opportunist and ubiquitous fungi belonging to the class Phygomycetes, subclass Zygomycetes, order Mucorales, family Mucoraceae. India has reported surge in cases of post COVID 19 Mucormycosis over the past few months due to the increasing frequency of risk factors like corticosteroid therapy, uncontrolled diabetes, DKA, neutropenia and iron overload. Patients with a history of COVID-19 infection are at increased risk of developing fungal infections like Mucormycosis. The emergence of COVID-19 associated mucormycosis (CAM) across several nations, particularly India, warrants a detailed study to identify potential contributing factors. MATERIAL: This cross sectional study conducted at Bowring and Lady Curzon Hospital, Bangalore, involving 75 subjects diagnosed with CAM either clinically, radiological or microbiologically. The objective was to study the clinical profile of patients with COVID associated Mucormycosis and to correlate the levels of Serum ferritin and iron profile with severity and extent of disease in COVID associated Mucormycosis patients Data was collected on demographic details, co morbidities, vaccination status, history of treatment with remedesvir, oxygen therapy or steroid use, complications of past COVID 19 infection and stage of current Mucormycosis infection. Clinical outcome of the patients measured based on Iron profile, length of hospital stay, need for ICU admission, presence of diabetic ketoacidosis and mortality. The blood investigations which included were CBC with differential leukocyte count, qCRP, FBS, PPBS, HbA1c serum iron studies and serum ferritin. OBSERVATION: The mean age of the subjects was 48.19 with 52 males, 23 females. Among 75 patients with CAM, 90.7% were unvaccinated against COVID-19, 62.7% had oxygen usage and steroid therapy, 44% had use of remedesvir. Most common co morbidity was diabetes mellitus 60% with 20% of patients having DKA. Rhino orbital-cerebral mucormycosis(Stage 4- 44.6%) was the most common clinical presentation. The mean serum iron (50.37) and TIBC (255.37) were significantly higher in Stage 4 CAM cases compared with less invasive stage 2 CAM cases. Patients with Stage 4 CAM had elevated levels of inflammatory markers LDH (292) DDimer (457) CRP(74.64). Case fatality rates of CAM was 12%. CONCLUSION: The results of this study revealed significant correlation between the clinical severity of CAM and higher mortality, increased serum iron levels and inflammatory markers in this population of patients. Therefore, patients with elevated levels of available serum iron are uniquely susceptible to mucormycosis infection, suggesting dysregulated iron metabolism in its pathogenesis.


Subject(s)
COVID-19 , Diabetic Ketoacidosis , Mucormycosis , Cross-Sectional Studies , Diabetic Ketoacidosis/complications , Female , Ferritins , Humans , India/epidemiology , Iron , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Oxygen/therapeutic use , Steroids/therapeutic use
4.
PLoS One ; 17(4): e0266809, 2022.
Article in English | MEDLINE | ID: covidwho-1793499

ABSTRACT

OBJECTIVE: To assess the risk of new-onset type 1 diabetes mellitus (T1D) diagnosis following COVID-19 diagnosis and the impact of COVID-19 diagnosis on the risk of diabetic ketoacidosis (DKA) in patients with prior T1D diagnosis. RESEARCH DESIGN AND METHODS: Retrospective data consisting of 27,292,879 patients from the Cerner Real-World Data were used. Odds ratios, overall and stratified by demographic predictors, were calculated to assess associations between COVID-19 and T1D. Odds ratios from multivariable logistic regression models, adjusted for demographic and clinical predictors, were calculated to assess adjusted associations between COVID-19 and DKA. Multiple imputation with multivariate imputation by chained equations (MICE) was used to account for missing data. RESULTS: The odds of developing new-onset T1D significantly increased in patients with COVID-19 diagnosis (OR: 1.42, 95% CI: 1.38, 1.46) compared to those without COVID-19. Risk varied by demographic groups, with the largest risk among pediatric patients ages 0-1 years (OR: 6.84, 95% CI: 2.75, 17.02) American Indian/Alaskan Natives (OR: 2.30, 95% CI: 1.86, 2.82), Asian or Pacific Islanders (OR: 2.01, 95% CI: 1.61, 2.53), older adult patients ages 51-65 years (OR: 1.77, 95% CI: 1.66, 1.88), those living in the Northeast (OR: 1.71, 95% CI: 1.61, 1.81), those living in the West (OR: 1.65, 95% CI: 1.56, 1.74), and Black patients (OR: 1.59, 95% CI: 1.47, 1.71). Among patients with diagnosed T1D at baseline (n = 55,359), 26.7% (n = 14,759) were diagnosed with COVID-19 over the study period. The odds of developing DKA for those with COVID-19 were significantly higher (OR 2.26, 95% CI: 2.04, 2.50) than those without COVID-19, and the largest risk was among patients with higher Elixhauser Comorbidity Index. CONCLUSIONS: COVID-19 diagnosis is associated with significantly increased risk of new-onset T1D, and American Indian/Alaskan Native, Asian/Pacific Islander, and Black populations are disproportionately at risk. In patients with pre-existing T1D, the risk of developing DKA is significantly increased following COVID-19 diagnosis.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Child , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/epidemiology , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/epidemiology , Humans , Retrospective Studies
5.
BMC Endocr Disord ; 22(1): 90, 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1779634

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus which causes COVID-19. It binds to the angiotensin-converting enzyme 2 (ACE2) receptors, expressed in key metabolic organs and tissues, including pancreatic beta cells, adipose tissue, the small intestine, and kidneys. This condition has been linked to a variety of additional symptoms, including acute encephalopathy, changes in consciousness, and even gastrointestinal bleeding. CASE PRESENTATION: In this study, we have reported a 13-year-old boy, 69 kg, with SARS-COV-2 infection. In this case, multiple systems, including the endocrine, renal, pulmonary, gastrointestinal, and nervous systems, were affected. CONCLUSIONS: It is speculated that different manifestations of COVID-19 can be seen in clinical settings, and practitioners should be more cautious not to miss the chimeric characteristics of COVID-19 infection.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Ketoacidosis , Hypertension , Adolescent , COVID-19/complications , Diabetic Ketoacidosis/complications , Humans , Hypertension/complications , Lung , Male , SARS-CoV-2
6.
BMJ Case Rep ; 15(4)2022 Apr 04.
Article in English | MEDLINE | ID: covidwho-1774938

ABSTRACT

We present an unusual case of a woman in her 30s who was admitted for diabetic ketoacidosis (DKA) in the setting of newly diagnosed but late COVID-19 infection with associated Klebsiella pneumoniae infection. Her altered mental status, out of proportion with her metabolic decompensation, revealed a superimposed cerebral venous sinus thrombosis (CVST) with fulminant cerebral oedema and ultimately brain death. This unusual and fulminant case of cerebral oedema in the setting of COVID-19 infection with bacterial infection, DKA and CVST was the perfect storm with multiple interwoven factors. It offered diagnostic and treatment challenges with an unfortunate outcome. This unique case is a reminder that it is important to consider a broad neurological differential in patients with COVID-19 with unexplained neurological manifestations, which may require specific neurointensive care management.


Subject(s)
Brain Edema , COVID-19 , Diabetes Mellitus , Diabetic Ketoacidosis , Sinus Thrombosis, Intracranial , Brain Edema/complications , Brain Edema/etiology , COVID-19/complications , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Female , Humans , Klebsiella pneumoniae , Sinus Thrombosis, Intracranial/complications , Sinus Thrombosis, Intracranial/diagnostic imaging
7.
Infect Dis (Lond) ; 54(7): 522-528, 2022 07.
Article in English | MEDLINE | ID: covidwho-1752046

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID 19) usually causes a mild illness among children. However, in a minority of children, it may be associated with the life-threatening multisystem inflammatory syndrome (MIS-C), or thrombotic microangiopathy, or sequelae like type-1 diabetes mellitus (T1DM). We describe a previously healthy, 12-year-old boy with new-onset T1DM with diabetic ketoacidosis (DKA) in the setting of MIS-C, with a course complicated by thrombotic microangiopathy. CASE PRESENTATION: The patient presented with four days history of fever, non-bilious vomiting, polyuria and polydipsia. On evaluation, he was noted to have diabetic ketoacidosis. Although Diabetic ketoacidosis with insulin and intravenous fluids, his hospital course was notable for shock requiring vasopressor, purpura fulminans with eschar formation, neurological manifestations (left hemiparesis due to right middle cerebral artery territory infarct, mononeuritis multiplex) and thrombotic microangiopathy. MIS-C-like illness secondary to COVID-19 was suspected due to diabetic ketoacidosis, thrombotic microangiopathy, elevated inflammatory markers, history of contact with COVID-19-infected individual and detectable COVID-19 IgG antibodies. He improved following management with methylprednisolone, intravenous immunoglobulin, low-molecular-weight heparin and aspirin, and was discharged on hospital day 48. CONCLUSION: MIS-C-like illness should be considered in children and adolescents presenting with complex multisystem involvement in this era of COVID 19. Management with immunomodulatory agents can be lifesaving.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Purpura Fulminans , Thrombotic Microangiopathies , Adolescent , COVID-19/complications , Child , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/therapy , Humans , Male , Purpura Fulminans/complications , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/therapy
8.
Diabetes Metab Syndr ; 16(1): 102389, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1683070

ABSTRACT

BACKGROUND AND AIM: Describe the prevalence/outcomes of Diabetic Ketoacidosis (DKA) patients comparing pre- (March-April 2019) and pandemic (March-April 2020) periods. METHODS: Retrospective cohort of admitted pandemic DKA/COVID-19+ patients comparing prevalence/outcomes to pre-pandemic DKA patients that takes place in Eleven hospitals of New York City Health & Hospitals. Our included participants during the pandemic period were admitted COVID-19+ patients (>18 years) and during the pre-pandemic period were admissions (>18 years) selected through the medical record. We excluded transfers during both periods. The intervention was COVID-19+ by PCR testing. The main outcome measured was mortality during the index hospitalization and secondary outcomes were demographics, medical histories and triage vital signs, and laboratory tests. Definition of DKA: Beta-Hydroxybutyrate (BHBA) (>0.4 mmol/L) and bicarbonate (<15 mmol/L) or pH (<7.3). RESULTS: Demographics and past medical histories were similar during the pre-pandemic (n = 6938) vs. pandemic (n = 7962) periods. DKA prevalence was greater during pandemic (3.14%, 2.66-3.68) vs. pre-pandemic period (0.72%, 0.54-0.95) (p > 0.001). DKA/COVID-19+ mortality rates were greater (46.3% (38.4-54.3) vs. pre-pandemic period (18%, 8.6-31.4) (p < 0.001). Surviving vs. non-surviving DKA/COVID-19+ patients had more severe DKA with lower bicarbonates by 2.7 mmol/L (1.0-4.5) (p < 0.001) and higher both Anion Gaps by 3.0 mmol/L (0.2-6.3) and BHBA by 2.1 mmol/L (1.2-3.1) (p < 0.001). CONCLUSIONS: COVID-19 increased the prevalence of DKA with higher mortality rates secondary to COVID-19 severity, not DKA. We suggest DKA screening all COVID-19+ patients and prioritizing ICU DKA/COVID-19+ with low oxygen saturation, blood pressures, or renal insufficiency.


Subject(s)
COVID-19/epidemiology , Diabetic Ketoacidosis/epidemiology , Patient Admission/statistics & numerical data , COVID-19/complications , COVID-19/therapy , Cohort Studies , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/therapy , Female , Humans , Male , Middle Aged , Pandemics , Prevalence , Retrospective Studies , SARS-CoV-2/physiology , United States/epidemiology
9.
Diabetes Care ; 45(4): 983-989, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1674210

ABSTRACT

OBJECTIVE: To report and describe cases of children presenting with coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C) with new-onset type 1 diabetes mellitus (T1DM) in severe diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS: This prospective observational study was conducted to characterize children with COVID-19-related MIS-C and new-onset T1DM who were in DKA. MIS-C was diagnosed if Centers for Disease Control and Prevention and World Health Organization criteria were fulfilled. RESULTS: Six cases were identified. The patients were critically ill and in nonfluid responsive shock (combined hypovolemic and cardiogenic or distributive shock). All had cardiac involvement. One patient had a Kawasaki shock-like presentation. All needed aggressive treatment with careful monitoring of fluid balance (because of associated cardiac dysfunction), early institution of vasoactive/inotropic supports, and use of methylprednisolone and intravenous immunoglobulins. The latter are better administered after DKA resolution to avoid undue volume overload and fluid shifts while the patients are in DKA. CONCLUSIONS: Awareness of MIS-C coexistence with DKA at T1DM onset is crucial for rapid proper management.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , COVID-19/complications , Child , Diabetes Mellitus, Type 1/diagnosis , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Humans , Systemic Inflammatory Response Syndrome/complications
10.
J Diabetes Complications ; 36(3): 108100, 2022 03.
Article in English | MEDLINE | ID: covidwho-1561363

ABSTRACT

BACKGROUND: Recent literature suggests a bi-directional relationship between COVID-19 infection and diabetes mellitus, with an increasing number of previously normoglycemic adults with COVID-19 being admitted with new-onset diabetic ketoacidosis (DKA). However, the possibility of COVID-19 being a potential trigger for A-ß + ketosis-prone diabetes (KPD) in these patients needs elucidation. Our study aimed at analyzing such a cohort of patients and determining their natural course of ß-cell recovery on serial follow-up. METHODS: After initial screening, n = 42 previously non-diabetic patients with new-onset DKA and RT-PCR positive COVID-19, were included in our ten-month follow-up study. Of these, n = 22 were negative (suspected A-ß + KPD) and n = 20 were positive (Type 1A DM) for autoantibodies (GAD/IA-2/ZnT8). Subsequently, n = 19 suspected KPD and n = 18 Type 1A DM patients were followed-up over ten months with serial assessments of clinical, biochemical and ß-cell secretion. Amongst the former, n = 15 (79%) patients achieved insulin independence, while n = 4 (21%) continued to require insulin at ten-months follow-up. RESULTS: On comparison, the suspected KPD patients showed significantly greater BMI, age, Hba1c, IL-6 and worse DKA parameters at presentation. Serial C-peptide estimations demonstrated significant ß-cell recovery in KPD group, with complete recovery seen in the 15 patients who became insulin independent on follow-up. Younger age, lower BMI, initial severity of DKA and inflammation (IL-6 levels), along-with reduced 25-hydroxy-Vitamin-D levels were associated with poorer recovery of ß-cell secretion at ten-month follow-up amongst the KPD patients, CONCLUSIONS: This is the first prospective study to demonstrate progressive recovery of ß-cell secretion in new-onset A-ß + KPD provoked by COVID-19 infection in Indian adults, with a distinctly different profile from Type 1A DM. Given their significant potential for ß-cell recovery, meticulous follow-up involving C-peptide estimations can help guide treatment and avoid injudicious use of insulin.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/epidemiology , Follow-Up Studies , Humans , India/epidemiology , Prospective Studies , SARS-CoV-2
12.
Am J Physiol Endocrinol Metab ; 322(1): E44-E53, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1518165

ABSTRACT

In December 2019, a pandemic emerged due to a new coronavirus that imposed various uncertainties and discoveries. It has been reported that diabetes is a risk factor for worst outcomes of COVID-19 and also that SARS-CoV-2 infection was correlated with the occurrence of diabetic ketoacidosis (DKA) in patients. The aim of this work is to discuss this correlation emphasizing the main case reports from 2020 while exploring the management of DKA during the course of COVID-19. Web of Science, PubMed, and Scopus databases were searched using two sets of Medical Subject Heading (MeSH) search terms or Title/Abstract words: Coronavirus Infections (Coronavirus Infections, Middle East Respiratory Syndrome, COVID-19) and Diabetic Ketoacidosis (Diabetic Ketoacidosis, Diabetic Acidosis, Diabetic Ketosis). There is a clear correlation between COVID-19 and DKA. The SARS-Cov-2 infection may precipitate both a hyperglycemic state and ketoacidosis occurrence in patients with diabetes and nondiabetic patients, which may lead to fatal outcomes. DKA in patients with COVID-19 may increase risk and worse outcomes. Hence, the SARS-Cov-2 infection presents a new perspective toward the management of glycemia and acidosis in patients with diabetes and nondiabetic patients, highlighting the need for rapid interventions to minimize the complications from COVID-19 while reducing its spreading.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Blood Glucose/analysis , Blood Glucose Self-Monitoring , COVID-19/metabolism , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/metabolism , Diabetic Ketoacidosis/drug therapy , Diabetic Ketoacidosis/metabolism , Humans , Hyperglycemia/complications , Hyperglycemia/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Prognosis , Risk Factors , Telemedicine
13.
Metabolism ; 122: 154842, 2021 09.
Article in English | MEDLINE | ID: covidwho-1406306

ABSTRACT

BACKGROUND: COVID-19 pandemic caused families to stay home and cancel everyday activities. Hospital admissions decreased, affecting changes in diagnoses and management of chronic disease in children. AIMS: We analyzed how the first lockdown influenced clinical presentation and manifestation of children with diabetes mellitus (DM) in a German University Hospital. METHODS: During March 15th and October 11th 2020, data on general patient information, clinical symptoms and on lab results related to diabetic ketoacidosis (DKA) were analyzed in children (0-18 years) who presented with new onset of DM or poor metabolic control of known DM. All data including frequency and severity of DKA were compared to data from patients who presented in 2019. RESULTS: Data from 125 participants with DM were evaluated (2020: n = 52; 2019: n = 73). In 2020, twelve patients (23.1%) were diagnosed with new onset DM, two of them with type2 diabetes, and 66.7% presented with DKA including both patients T2DM. In 2019, 24.5% of patients had new onset DM, and 50% of them presented with DKA. In 2020, patients with new onset DM were younger, presented with more severe symptoms of DKA and had to stay longer in hospital compared to 2019. In 2020, six children (50%) with new onset DM were <6 years, whereas in 2019 most children with new onset DM were adolescents (n = 7, 38.9%). CONCLUSION: COVID-19 lockdown aggravated complications of diabetes onset and therapy management, including severity and frequency of DKA. It underlines the need of health education for early DKA diagnosis to early identify children at risk.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Diabetic Ketoacidosis/complications , Pandemics , Adolescent , Adult , COVID-19/complications , Child , Female , Humans , Male , Young Adult
14.
Ann Med ; 53(1): 1642-1645, 2021 12.
Article in English | MEDLINE | ID: covidwho-1404914

ABSTRACT

OBJECTIVE: To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (-) [COVID (-)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area. METHODS: A cross-sectional study was conducted with patients admitted to an urban academic medical center between 1 March and 30 July 2020. Eligible patients met lab criteria for either DKA or HHS. Mixed DKA-HHS was defined as meeting all criteria for either DKA or HHS with at least 1 criterion for the other diagnosis. RESULTS: A total of 82 participants were stratified by COVID-19 status and type of hyperglycaemic crisis [26 COVID (+) and 56 COVID (-)]. A majority were either Black or Hispanic. Compared with COVID (-) patients, COVID (+) patients were older, more Hispanic and more likely to have type 2 diabetes (T2D, 73% vs 48%, p < .01). COVID(+) patients had a higher mean pH (7.25 ± 0.10 vs 7.16 ± 0.16, p < .01) and lower anion gap (18.7 ± 5.7 vs 22.7 ± 6.9, p = .01) than COVID (-) patients. COVID (+) patients were given less intravenous fluids in the first 24 h (2.8 ± 1.9 vs 4.2 ± 2.4 L, p = .01) and were more likely to receive glucocorticoids (95% vs. 11%, p < .01). COVID (+) patients may have taken longer to resolve their hyperglycaemic crisis (53.3 ± 64.8 vs 28.8 ± 27.5 h, p = .09) and may have experienced more hypoglycaemia <3.9 mmol/L (35% vs 19%, p = .09). COVID (+) patients had a higher length of hospital stay (LOS, 14.8 ± 14.9 vs 6.5 ± 6.0 days, p = .01) and in-hospital mortality (27% vs 7%, p = .02). DISCUSSION: Compared with COVID (-) patients, COVID (+) patients with DKA/HHS are more likely to have T2D. Despite less severe metabolic acidosis, COVID (+) patients may require more time to resolve the hyperglycaemic crisis and experience more hypoglycaemia while suffering greater LOS and risk of mortality. Larger studies are needed to examine whether differences in management between COVID (+) and (-) patients affect outcomes with DKA/HHS.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/complications , Acid-Base Equilibrium , Adult , Age Factors , Aged , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/blood , Female , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Hydrogen-Ion Concentration , Hyperglycemic Hyperosmolar Nonketotic Coma/blood , Length of Stay , Male , Middle Aged , SARS-CoV-2 , Safety-net Providers
15.
Diabetes Metab Syndr ; 15(5): 102231, 2021.
Article in English | MEDLINE | ID: covidwho-1333363

ABSTRACT

BACKGROUND AND AIM: This review aims to report the current status of COVID-19 among people with diabetes, newly diagnosed diabetes, diabetic ketoacidosis, and programmatic efforts including vaccinations. METHODS: We conducted a literature search using PubMed, Google, and Scopus until July 15, 2021. RESULTS: In Saudi Arabia, most studies have reported diabetes as one of the highly prevalent comorbidities among patients with COVID-19. Currently, there are limited studies from Saudi Arabia on the newly diagnosed diabetes and diabetic ketoacidosis caused by COVID-19. The Saudi ministry has taken several measures to control the impact of COVID-19 among people with diabetes, including comprehensive guidelines and prioritized vaccinations. During the COVID-19 pandemic, the use of telehealth services dramatically increased in diabetes clinics in Saudi Arabia. CONCLUSIONS: Focused and evidence-based interventions are essential to control the impact of COVID-19 among people with diabetes.


Subject(s)
COVID-19/epidemiology , Diabetes Complications/epidemiology , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Diabetes Complications/complications , Diabetes Mellitus/epidemiology , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/epidemiology , Humans , Pandemics , SARS-CoV-2/physiology , Saudi Arabia/epidemiology , Vaccination/statistics & numerical data
16.
J Investig Med High Impact Case Rep ; 9: 23247096211021231, 2021.
Article in English | MEDLINE | ID: covidwho-1259169

ABSTRACT

We report 11 cases of combined diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK) in coronavirus 2019 patients who presented to our institution in New Jersey, USA. The median age was 47 years (range 12-88 years). Out of the 11 patients, 7 were male and 4 were female. Out of 11 patients, 8 had type 2 diabetes mellitus (DM), 2 had undiagnosed DM, and 1 had type 1 DM. Presenting complaints included altered mental status, weakness, shortness of breath, cough, fever, vomiting, abdominal pain, chest pain, and foot pain. Out of 11 patients, pneumonia was diagnosed at presentation in 8 patients, while in 3 patients, chest X-ray was clear. Median value of initial glucose on presentation was 974 mg/dL (range 549-1556 mg/dL), and hemoglobin A1c on presentation was 13.8%. The median value of anion gap was 34 mEq/L. Out of the 11 patients, ketonemia was moderate in 6 patients, large in 3, and small in 2 patients. Acute kidney injury (AKI) occurred in 9 patients and 2 patients required renal replacement therapy. Out of the 11 patients, 6 required mechanical ventilation and 7 patients died. All the 6 patients requiring mechanical ventilation died. Our case series shows COVID-19 infection can precipitate acute metabolic complications in known DM patients or as first manifestation in undiagnosed DM patients. Patients can present with DKA/HHNK symptoms and/or respiratory symptoms. Mechanical ventilation is a poor prognostic factor. Further studies are needed to characterize prognostic factors associated with mortality in this vulnerable patient population.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/complications , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/therapy , Child , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Middle Aged , Renal Replacement Therapy , Respiration, Artificial , SARS-CoV-2 , Treatment Outcome , Young Adult
18.
Am J Emerg Med ; 49: 437.e5-437.e8, 2021 11.
Article in English | MEDLINE | ID: covidwho-1198570

ABSTRACT

Patients with diabetes have increased susceptibility to infection with Severe acute respiratory syndrome-coronavirus 2 and increased morbidity and mortality from Coronavirus disease 2019 (COVID-19) infection. Mortality from COVID-19 is sometimes caused by cardiac arrhythmias. Electrolyte disturbances in patients with diabetic ketoacidosis (DKA) can increase the risk of cardiac arrhythmias. Despite these correlations, little has been reported about the co-incidence of these three conditions: COVID-19, DKA and cardiac arrhythmias. In this case report we describe two children with COVID-19, new-onset DKA and cardiac arrhythmias. These cases emphasize the importance of close cardiac and electrolyte monitoring in patients with COVID-19 infection.


Subject(s)
Arrhythmias, Cardiac/complications , COVID-19/complications , Diabetic Ketoacidosis/complications , Adolescent , Arrhythmias, Cardiac/therapy , COVID-19/therapy , Child , Diabetic Ketoacidosis/therapy , Electrocardiography , Female , Humans , Male , Treatment Outcome
19.
J Med Virol ; 93(2): 1150-1153, 2021 02.
Article in English | MEDLINE | ID: covidwho-1196419

ABSTRACT

Novel coronavirus disease 2019 (COVID-19), a 2020 pandemic, has resulted in an unexpected loss in lives, quality of life, and the economy. The COVID-19 clinical spectrum varies from asymptomatic to death, and its complications may involve various organs. Notwithstanding, the impact of COVID-19 on endocrine systems is understudied. Previous coronavirus outbreaks such as severe acute respiratory syndrome coronavirus can cause new-onset diabetes mellitus (DM). However, there were only two previous case reports on newly diagnosed DM in COVID-19 patients. Here, we described three patients who had newly diagnosed DM associated with COVID-19. COVID-19 likely unmasked existing DM by aggravating its metabolic complications rather than causing the new-onset DM in these patients. However, more research is needed to evaluate if there is a casual relationship between the development of DM, DKA, and COVID-19.


Subject(s)
COVID-19/complications , Diabetes Mellitus/diagnosis , Diabetic Ketoacidosis/diagnosis , Adolescent , Diabetic Ketoacidosis/complications , Female , Humans , Male , Middle Aged , Quality of Life
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