Endocrine Abstracts

Traditional literature agrees that Diabetic Ketoacidosis is typically associated with Type 1 Diabetes Mellitus, but can be associated with stress including infections in Type 2 diabetics. The authors did a restrospective evaluation of diabetic ketoacidosis presenting to a large district hospital in London. 343 patients were admitted with diagnosis of Diabetic Ketoacidosis during the COVID peaks from January 2020 to January 2021. 57% of these were Type 1 diabetics and 43% were found to be Type 2 diabetics. 23% of the patients admitted with Type 2 diabetes and DKA did not have a previous presentation with ketosis. 68% of both Type 1 and Type 2 diabetics tested negative for COVID 19 on first/second swab (accounting for hospital exposure). 56% of Type 2 diabetics with DKA tested positive for COVID-19 on first/second swab. 32% of Type 2 diabetics were new diagnosis of diabetes. Initial studies agreed a significant increase in ketosis prone DKA in Type 2 diabetics during COVID times however were unable to establish a clear correlation with COVID infection. Our Initial studies did suggest a possible extrapolation with widespread vaccination of a possible emerging cohort of ketosis prone type 2 diabetes. We therefore evaluated the incidence of ketosis prone type 2 DKA in vaccinated individuals with a total of 178 admissions with diabetic ketoacidosis evaluated between August 2021 and December 2021. 58.7% of patients admitted with diabetic ketoacidosis were Type 2 diabetics. 23% of patients presenting with diabetic ketoacidosis were new diagnosis of diabetes (19% Type 1 Diabetes). An overall increase in monthly admissions over five months was noted when compared to previous one year evaluated was noted. The authors suggest that exposure/immunity to COVID 19 may be a contributing factor to increase in ketosis prone diabetic ketoacidosis. Several etiologies may be suggested including viral destruction of beta cells in patients with widespread subclinical infection or possible role of antibodies in vaccinated individuals. More research is needed for the same particularly with emergence of variants and widespread vaccination as this has potential to change the understood epidemiology of Type 2 Diabetes.