Hyperglycaemic emergencies during the COVID-19 pandemic in East London, one of the worst affected areas in the UK

ABSTRACT

Introduction: Diabetes is an established risk factor for poor outcome in COVID-19. Additionally, the pandemic has resulted in patients delaying hospital attendance with emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). We examined adult admissions for hyperglycaemic emergencies to Newham University Hospital during the first and second COVID-19 waves. Results: 38 adults presented in wave ( March to 3 May 2020) DKA, 4 HHS, 3 mixed DKA/HHS. Median age was 62 years and 58% were male. 63% were Afro-Caribbean,13% Caucasian,11% Asian. 68% had known T2DM, 6% known TDM and 6% newly diagnosed diabetes. Mean BMI was 27.3 kg/m2, mean HbA1c (within one year) was 90.6 mmol/mol. 6 patients (42%) had PCR-confirmed COVID-19 on admission. In wave 2 ( November 2020 to 28 February 202) 59 adults presented 34 DKA, 2 HHS, 3 mixed DKA/HHS. Median age was 55 years and 6 % were male. 39% were Afro-Caribbean, 27% Caucasian, 7 % Asian. 6 % had known T2DM, 29% known TDM and 0% newly diagnosed diabetes. Mean BMI was 27.9 kg/m2, mean HbA1c was 96 mmol/mol. 8 patients (3%) had PCR-confirmed COVID-19 on admission. In both waves most patients were male, had T2DM with poor pre-admission glycaemic control and most were overweight/obese. Mixed DKA/HHS was unusually prevalent. During wave 2, patients were younger, COVID-19 was less frequent, more patients with TDM were admitted, when DKA predominated and only two patients with TDM had COVID-19. Hyperglycaemic emergency admissions differed between the two waves, with wave 2 seeing increased TDM admissions and more presentations independent of COVID-19 . Discussion: Better understanding of factors underlying these presentations could help to improve patient support during this time.