ECE2020 Audio ePoster Presentations Hot topics (including COVID-19) (110 abstracts)
Diabetic emergencies during COVID-19 –A multi-centre experience
Sulmaaz Qamar 1 , Umaira Aziz 2 , Sadia Nasir 3 , Eleni Armeni 1 , Maya Zosmer 1 , Tobin Joseph 1 , Eleanor Crawley 1 , Susan Tutty 1 , Jo Lynch 1 , Pierre Bouloux 4 , Ahmed Yousseif 2 , Sidrah Khan 3 , Ravi Menon 1 , Chidambaram Nethaji 1 & Efthimia Karra 2
1North Middlesex University Hospital, United Kingdom; 2Royal Free Hospital, United Kingdom; 3Peterborough City Hospital, United Kingdom; 4University College Hospital, United Kingdom
Introduction: Diabetes mellitus is as a major contributor to disease severity and mortality in patients with Covid-19 infection, as the estimated increase in risk of death in hospitalised patients is 3.5-times (for T1DM) and 2.03-times (for T2DM).
This retrospective analysis recruited 35 patients from three London hospitals who presented with diabetic emergencies i.e. diabetic ketoacidosis (DKA), Hyperglycaemic hyperosmolar state( HHS), presence of ketoneamia (beta-hydroxybutyrate > 0.6 mmol/l) as well as with positive SARS-CoV-2 PCRduring March 2020.
Results: Median age was 60 years (male 67.5%). 11 (31.4%) of patients had DKA, 13 (37.1%) patients had mixed DKA and HHS picture, 9 (25.7%) presented with hyperglycaemic ketosis and 2 (5.8%) patients had HHS. 17(48.6%) were of African origin and 6 (17.1%) mixed race.80% had T2DM and 5.7% had new diagnosis of diabetes. Across all cases the degree of ketoneamia was negatively correlated with pH (P-value = 0.035), HCO3 (P-value < 0.001) and base excess (P-value = 0.001). Time to ketone resolution was positively associated with fluid volume required (P-value = 0.047) and negatively correlated with pH (P-value = 0.025), HCO3 (P-value = 0.015) and base excess (P-value = 0.007). Median time taken to ketone resolutionfor all patients was 24 hr (IQR 14.6–36), and 35hr (IQR 24–60) for DKA. Median time to ICU admission was 3.00 ± 1.23 days, median length of stay for discharged patients was 18.0 ± 3.98 days. 13 patients were still inpatients at the time of study, 5.7% (n = 2/35) of patient’snon-insulin treated previously, had died (DKA n = 1; mixed DKA/HHS n = 1).
Conclusion: This study shows overrepresentation of T2DM amongst patients admitted with DKA in the context of Covid-19 infection. Our patients, mainly of African/Afro-Caribbean background, had protracted ketoneamia and ketoacidosis with prolonged time to resolution.
These results indicate a possible effect of the ethnic background on the clinical outcome in patients admitted with diabetes emergencies in the context of Covid-19 infection. Large scale observational studies are needed to understand the insulopenic effects of COVID-19.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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