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Temporal trends in emergency admissions for diabetic ketoacidosis in people with diabetes in England before and during the COVID-19 pandemic: a population-based study.
Misra, Shivani; Barron, Emma; Vamos, Eszter; Thomas, Stephen; Dhatariya, Ketan; Kar, Partha; Young, Bob; Khunti, Kamlesh; Valabhji, Jonathan.
  • Misra S; National Diabetes Audit Programme, NHS England and NHS Improvement, London, UK; Division of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Clinical Biochemi
  • Barron E; National Diabetes Audit Programme, NHS England and NHS Improvement, London, UK; NHS England and NHS Improvement, London UK.
  • Vamos E; School of Public Health, Imperial College London, London, UK.
  • Thomas S; Department of Diabetes and Endocrinology, Guys and St Thomas' NHS Trust, London, UK.
  • Dhatariya K; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
  • Kar P; National Diabetes Audit Programme, NHS England and NHS Improvement, London, UK; NHS England and NHS Improvement, London UK; Portsmouth Hospitals NHS Trust, Portsmouth, UK.
  • Young B; National Diabetes Audit Programme, NHS England and NHS Improvement, London, UK.
  • Khunti K; National Diabetes Audit Programme, NHS England and NHS Improvement, London, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
  • Valabhji J; National Diabetes Audit Programme, NHS England and NHS Improvement, London, UK; Division of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK; Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; NHS England and N
Lancet Diabetes Endocrinol ; 9(10): 671-680, 2021 10.
Article in English | MEDLINE | ID: covidwho-1531932
ABSTRACT

BACKGROUND:

Diabetic ketoacidosis (DKA) has been reported to be increasing in frequency during the COVID-19 pandemic. We aimed to examine the rates of DKA hospital admissions and the patient demographics associated with DKA during the pandemic compared with in prepandemic years.

METHODS:

Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, we extracted all emergency hospital admissions in England coded with DKA from March 1 to June 30, 2020 (first wave of the pandemic), July 1 to Oct 31, 2020 (post-first wave), and Nov 1, 2020, to Feb 28, 2021 (second wave), and compared these with DKA admissions in the equivalent periods in 2017-20. We also examined baseline characteristics, mortality, and trends in patients who were admitted with DKA.

FINDINGS:

There were 8553 admissions coded with DKA during the first wave, 8729 during the post-first wave, and 10 235 during the second wave. Compared with preceding years, DKA admissions were 6% (95% CI 4-9; p<0·0001) higher in the first wave of the pandemic (from n=8048), 6% (3-8; p<0·0001) higher in the post-first wave (from n=8260), and 7% (4-9; p<0·0001) higher in the second wave (from n=9610). In the first wave, DKA admissions reduced by 19% (95% CI 16-21) in those with pre-existing type 1 diabetes (from n=4965 to n=4041), increased by 41% (35-47) in those with pre-existing type 2 diabetes (from n=2010 to n=2831), and increased by 57% (48-66) in those with newly diagnosed diabetes (from n=1072 to n=1681). Compared with prepandemic, type 2 diabetes DKA admissions were similarly common in older individuals and men but were higher in those of non-White ethnicities during the first wave. The increase in newly diagnosed DKA admissions occurred across all age groups and these were significantly increased in men and people of non-White ethnicities. In the post-first wave, DKA admissions did not return to the baseline level of previous years; DKA admissions were 14% (11-17) lower in patients with type 1 diabetes (from n=5208 prepandemic to n=4491), 30% (24-36) higher in patients with type 2 diabetes (from n=2011 to n=2613), and 56% (47-66) higher in patients with newly diagnosed diabetes (from n=1041 to n=1625). During the second wave, DKA admissions were 25% (22-27) lower in patients with type 1 diabetes (from n=5769 prepandemic to n=4337), 50% (44-56) higher in patients with type 2 diabetes (from n=2608 to n=3912), and 61% (52-70) higher in patients with newly diagnosed diabetes (from n=1234 to n=1986).

INTERPRETATION:

Our results provide evidence for differences in the numbers and characteristics of people presenting with DKA during the COVID-19 pandemic compared with in the preceding 3 years. Greater awareness of risk factors for DKA in type 2 diabetes and vigilance for newly diagnosed diabetes presenting with DKA during the COVID-19 pandemic might help mitigate the increased impact of DKA.

FUNDING:

None.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Patient Admission / Population Surveillance / Diabetic Ketoacidosis / Diabetes Mellitus, Type 2 / Emergency Service, Hospital / COVID-19 Subject: Patient Admission / Population Surveillance / Diabetic Ketoacidosis / Diabetes Mellitus, Type 2 / Emergency Service, Hospital / COVID-19 Type of study: Risk factors / Screening study Language: English Journal: Lancet Diabetes Endocrinol Clinical aspect: Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Patient Admission / Population Surveillance / Diabetic Ketoacidosis / Diabetes Mellitus, Type 2 / Emergency Service, Hospital / COVID-19 Subject: Patient Admission / Population Surveillance / Diabetic Ketoacidosis / Diabetes Mellitus, Type 2 / Emergency Service, Hospital / COVID-19 Type of study: Risk factors / Screening study Language: English Journal: Lancet Diabetes Endocrinol Clinical aspect: Etiology Year: 2021
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