Endocrine Abstracts

Introduction

In march 2020, the COVID-19 pandemic registered its first cases in Portugal, leading the government to impose lockdown, in order to prevent the spread of cases. With social isolation and outpatient activity being ceased, there was an increase in mortality of non-COVID patients. The lockdown recommendations are in contradiction with comprehensive diabetes care and reflected in less regular patient-provider interactions, which in some cases contributed to the worsening of glycemic control and presentation with acute complications of diabetes.

Aim

To evaluate the impact of lockdown in the severity and characteristics of hyperglycemic emergencies (diabetic ketoacidosis [DKA] and hyperosmolar hyperglicemic state [HHS]).

Methods

Retrospective single center study. We included patients with a diagnosis of DKA or HHS admitted in the lockdown months (march to may 2020). The control group were patients admitted with DKA or HHS in the homologous period of 2019.

Results

18 patients were admitted in 2020 and 12 in 2019. The mean age was 48 (± 24) years in 2019 and 60 (± 26) in 2020 (P = 0.192). HHS represented 50% of cases in 2020 and 25% in 2019 (P = 0.171). In the lockdown period patients were more likely to have type 2 diabetes (55.6% vs 33.3%, P = 0.232), had a higher number of comorbidities (2.4 ± 1.4 vs 1 ± 0.9, P = 0.009), more microvascular complications (50% vs 8.3%, P = 0.049), and usual attendance at primary care services (61.1% vs 16.7%, P = 0.008). At admission, lockdown patients were more likely to present with dehydration (55.6 vs. 9.1%, P = 0.009) and altered mental status (61.1 vs 25%, P = 0.048). There were more cases of severe DKA in 2020 (45.5% vs 0%, P = 0.038). Although with statistically not significant difference, patients had tendentially higher urea (39.5 vs 30.5 mg/dl, P = 0.391), creatinine levels (1.85 vs 1.42 mg/dl, P = 0.051) and osmolarity (310 vs 293 mOsm/kg, P = 0.172); more complications during in-hospital stay (38.9 vs 8.3%, P = 0.064) and higher mortality (16.7 vs 0%, P = 0.136). The cases of initial presentation of diabetes did not differ between periods (16.7%).

Conclusion

During lockdown there were more admissions with acute hyperglycemic emergencies, those with more severe presentations, resulting in a higher fatality rate. Reduced access to primary care and hospital services for diabetes, combined with fear of exposure to the virus in these settings drive to delayed care-seeking. Telehealth or telephonic consultations should be encouraged to prevent complications and ensure access to therapy. Download of records from insulin pumps/CGM should be used whenever possible to optimize glucose control.