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Article: COVID-19 and Diabetic Ketoacidosis: A Single Center Experience.

Singh, Balraj / Kaur, Parminder / Patel, Prem / Reid, Ro-Jay / Kumar, Abhishek / Kaur, Supreet / Guragai, Nirmal / Rushdy, Abanoub / Bikkina, Mahesh / Shamoon, Fayez

Cureus

2021 Volume 13, Issue 1, Page(s) e13000

Abstract: ... coronavirus disease 2019 (COVID-19) patients with diabetic ketoacidosis (DKA) -- a single center ... shows that COVID-19 is associated with substantial mortality in DKA patients and adds to the limited ... tertiary hospital experience.: Materials and methods: A retrospective study was conducted among patients ...

Abstract	Background and objectives: To describe the clinical characteristics and outcomes of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetic ketoacidosis (DKA) -- a single center tertiary hospital experience. Materials and methods: A retrospective study was conducted among patients admitted to our hospital in the United States between March 1 Results: A total number of 43 patients were included in this study. The median age was 52 years. Thirty-three (76.7%) patients were male. Median value of initial glucose on presentation was 553 mg/dL (300.0-1927.0 mg/dL). On admission, 33 (76.7%) patients had glycated hemoglobin (HbA1c) ≥ 8% (64 mmol/mol) and HbA1c was not obtained in 10 (23.3%) patients. Acute kidney injury (AKI) was seen in 37 (86.0%) patients, 6 (14%) patients required renal replacement therapy and 22 (51.2%) required mechanical ventilation. Among the 43 patients, 25 (58.1%) died. Out of 25 patients who died 15 (60.0%) were Hispanics, 6 (24.0%) were White, 3 (12.0%) were African American, 1 (4%) was Arabic, and 1 (4%) was Asian. The patients who died were older in age than who survived (mean age 58 ± 6.13 vs 46 ± 9.39; p = 0.023). Some 95% of the patients requiring mechanical ventilation died (odds ratio [OR]: 89.25; 95% confidence interval [CI]: 9.10-874.96); p = 0.001). Compared to survivors, nonsurvivors had significantly higher d-dimer (13.00 ± 3.20 mcg/mL vs 6.15 ± 3.66 mcg/mL; p< 0.006) and peak ferritin values (2763.66 ± 1105.32 ng/mL vs 835.16 ± 257.07 ng/mL; p= 0.016). Conclusion: Our retrospective study shows COVID-19 infection may present as DKA in patients with diabetes mellitus (DM). Older age, mechanical ventilation, elevated d-dimer, and ferritin are associated with poor prognosis in these patients. Our study shows that COVID-19 is associated with substantial mortality in DKA patients and adds to the limited literature available regarding poor risk factors associated with mortality in these patients.
Language	English
Publishing date	2021-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.13000
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Article ; Online: Increased severity of presentation signs in children with newly diagnosed Type 1 Diabetes during the COVID-19 pandemic: A tertiary center experience.

İzci Güllü, Elif / Akin, Leyla / Enes Gökler, Mehmet / Aydin, Murat

Annals of nutrition & metabolism

2024

Abstract: ... increased ICA positivity in the pandemic may support the effects of COVID-19 on autoimmune T1DM. ... In this single tertiary center retrospective cohort study newly diagnosed T1DM patients were grouped as pre ... Introduction: Diabetic ketoacidosis (DKA) is an important complication of Type 1 Diabetes Mellitus ...

Abstract	Introduction: Diabetic ketoacidosis (DKA) is an important complication of Type 1 Diabetes Mellitus (T1DM) which is worsened when the diagnosis of T1DM is delayed. The aim of this study was to evaluate the presentation patterns, severity, autoantibody status and seasonal variability of newly diagnosed T1DM patients during the pandemic period of two years compared to those in the pre-pandemic period. Methods: In this single tertiary center retrospective cohort study newly diagnosed T1DM patients were grouped as pre-pandemic and pandemic period. Age, gender, the month of diagnosis, hemoglobinA1c (HbA1c), venous blood gas parameters, duration of symptoms, glutamic-acid-decarboxylase-antibody (anti GAD), islet-cell antibody (ICA) and insulin autoantibody (IAA) levels were recorded. The data obtained were compared between the groups. Results: Number of patients presenting with DKA was significantly higher during the pandemic period (92 (65.7%) vs. 62 (40.8%) patients, p<0.001). In terms of clinical severity of DKA, pH, and HCO3 levels were lower during the pandemic period (p<0.001), while the number of patients presenting with severe DKA was significantly higher during the pandemic period (41 (44.6%) vs. 17 (27.4%) patients, p=0.031). ICA positivity was significantly higher in patients admitted during the pandemic period (47 (36.4%) vs. 21 patients (16.9%), p<0.001), especially in the second year of the pandemic (p<0.001). Anti GAD-ICA co-positivity was significantly higher in patients admitted during the pandemic period and also in second year of the pandemic (p<0.001). Conclusion: DKA rates increased in newly diagnosed T1DM cases during the pandemic. Despite the relaxation of bans, the second year of the pandemic also saw increased rates of DKA and severe DKA compared to the pre-pandemic period. The significantly increased ICA positivity in the pandemic may support the effects of COVID-19 on autoimmune T1DM.
Language	English
Publishing date	2024-03-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	392341-1
ISSN	1421-9697 ; 0250-6807 ; 1018-9688
ISSN (online)	1421-9697
ISSN	0250-6807 ; 1018-9688
DOI	10.1159/000538322
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Article ; Online: Glycemic variability and time in range among children with type 1 diabetes on insulin pump during the Covid-19 pandemic in Egypt; single center experience.

Maksoud, Abeer Ahmed Abdel / Salah, Nouran Yousef / Ayoup, Safaa Alshraki Alsayed

BMC endocrine disorders

2023 Volume 23, Issue 1, Page(s) 262

Abstract: ... on insulin pump therapy from this single center during the covid-19 pandemic. ... To assess the impact of Covid-19 on glycemic control and acute complications among children with T1DM ... problems, frequency of diabetic-ketoacidosis (DKA), hypoglycemia and HbA1C. Continuous-glucose monitoring ...

Abstract	Background: Covid-19 has impacted the lives of individuals worldwide especially those with chronic illnesses. Children with type 1 diabetes (T1DM) are at risk of glycemic deterioration during the Covid-19 pandemic. However, some studies reported glycemic improvement in these children during the pandemic. Aim: To assess the impact of Covid-19 on glycemic control and acute complications among children with T1DM on insulin pump in Egypt. Methodology: Forty-two children with T1DM on insulin pump for at least 1 year were assessed during the period from June 2020 to May 2021 for insulin requirements, insulin-pump problems, frequency of diabetic-ketoacidosis (DKA), hypoglycemia and HbA1C. Continuous-glucose monitoring was done using Medtronic i-pro device for 5 days. Data were compared to those obtained from the patients' medical records 1 year previously. Result: Upon comparing data during Covid-19 pandemic with previous data from 12-24 months before Covid-19, there was a significant small increase in the mean total daily insulin dose from 0.83 ± 0.28 to 0.88 ± 0.30 U/kg/day with a similar small increase in the mean basal percentage from 51.19 ± 3.46 to 52.74 ± 4.31. Interestingly, the median time in range showed small increase from 53 (IQR 47-61) to 57.0 (IQR 51-73), the mean coefficient of variation showed small decrease from 42.10 ± 9.90 to 38.20 ± 8.12 and the mean HbA1C significantly decreased from 8.8 ± 1.3 (72.31 ± 16.78 mmol/ml) to 7.8 ± 1.2 mg/dl (61.31 ± 16.62 mmol/mol). Twenty-nine children (69%) had insulin-pump problems in the form of skin irritation (31%), skin infection (7.1%) and pump Set/Site occlusion (31%). Conclusion: No safety issues and overall glycemic improvement were reported among the children with T1DM on insulin pump therapy from this single center during the covid-19 pandemic.
MeSH term(s)	Humans ; Child ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/drug therapy ; Diabetes Mellitus, Type 1/epidemiology ; Hypoglycemic Agents/therapeutic use ; Pandemics ; Blood Glucose ; Glycated Hemoglobin ; Egypt/epidemiology ; Blood Glucose Self-Monitoring ; COVID-19/epidemiology ; COVID-19/complications ; Insulin/therapeutic use ; Diabetic Ketoacidosis/complications
Chemical Substances	Hypoglycemic Agents ; Blood Glucose ; Glycated Hemoglobin ; Insulin
Language	English
Publishing date	2023-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2091323-0
ISSN	1472-6823 ; 1472-6823
ISSN (online)	1472-6823
ISSN	1472-6823
DOI	10.1186/s12902-023-01517-w
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Article: Increase in the Number of Pediatric New-Onset Diabetes and Diabetic Ketoacidosis Cases During the COVID-19 Pandemic.

Chambers, Melissa A / Mecham, Cherisse / Arreola, Elsa Vazquez / Sinha, Madhumita

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2022 Volume 28, Issue 5, Page(s) 479–485

Abstract: ... in new-onset diabetes and DKA prior to and following the onset of the COVID-19 pandemic.: Methods ... of hospitalization and were significantly more likely to experience severe DKA (odds ratio, 2.17; 95 ... A significant increase in T2D cases occurred following the onset of the COVID-19 pandemic with a greater risk ...

Abstract	Objective: Infection with SARS-CoV-2 induces a proinflammatory state that causes hyperglycemia and may precipitate diabetic ketoacidosis (DKA) in patients with known or new-onset diabetes. We examined the trends in new-onset diabetes and DKA prior to and following the onset of the COVID-19 pandemic. Methods: This single-center retrospective observational study included pediatric patients (aged 0 to <18 years) hospitalized with new-onset type 1 diabetes or type 2 diabetes (T2D) before (March 1, 2018, to February 29, 2020) and after (March 1, 2020 to December 31, 2020) the pandemic onset. Demographic, anthropometrics, laboratory and clinical data, and outcomes were obtained. Results: Among 615 children admitted with new-onset diabetes during the entire study period, 401 were admitted before the pandemic onset, and 214 were admitted after the pandemic onset. Children admitted with new-onset diabetes in the postpandemic period were significantly more likely to present with DKA (odds ratio, 1.76; 95% confidence interval, 1.24-2.52) than in the prepandemic phase. Children with DKA after the pandemic onset had higher lengths of hospitalization and were significantly more likely to experience severe DKA (odds ratio, 2.17; 95% confidence interval, 1.34-3.52). A higher proportion of children with DKA admitted to the pediatric intensive care unit required oxygen support after the pandemic onset than before the pandemic onset (8.85% vs 1.92%). Most cases of T2D with DKA occurred following the onset of the pandemic (62.5%). Conclusion: A significant increase in T2D cases occurred following the onset of the COVID-19 pandemic with a greater risk of DKA and severe ketoacidosis. Racial disparity was evident with a higher proportion of Black and American Indian children presenting with ketoacidosis following the pandemic onset.
MeSH term(s)	COVID-19/epidemiology ; Child ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/epidemiology ; Diabetic Ketoacidosis/epidemiology ; Diabetic Ketoacidosis/etiology ; Humans ; Ketosis/complications ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2022-02-18
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.1016/j.eprac.2022.02.005
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Article ; Online: Does the severity of diabetic ketoacidosis in children with type 1 diabetes change during the COVID-19 pandemic? A single-center experience from a pediatric intensive care unit.

Varol, Fatih / Ozyilmaz, Leyla Gizem Bolac / Sahin, Ebru Guney / Can, Yasar Yusuf / Altas, Ugur / Cam, Halit

Northern clinics of Istanbul

2022 Volume 9, Issue 5, Page(s) 429–435

Abstract: ... of being infected with COVID-19. Under this situation, we conducted this study to evaluate the clinical and ... the COVID-19 pandemic. While there was no significant difference in pH and HCO: Conclusion: Higher HbA1c ... to the health institutions due to COVID-19 and the length of insulin-free periods compared to pre-diagnosed ...

Abstract	Objective: During the COVID-19 pandemic, health-care services for diseases other than COVID-19 were interrupted, and patient referrals to health institutions were postponed due to their fear of being infected with COVID-19. Under this situation, we conducted this study to evaluate the clinical and laboratory findings of COVID-19 in patients with Type 1 Diabetes Mellitus (T1DM) hospitalized in our pediatric intensive care unit (PICU) with the diagnosis of diabetic ketoacidosis (DKA) during the pandemic period, and the impact of the pandemic on these findings. Methods: We retrospectively evaluated 55 children aged from 1 month to 18 years old, diagnosed with DKA, and followed up at Istanbul Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital PICU between April 2020 and December 2021. Results: A total of 55 patients with DKA as a complication of T1DM were admitted to the PICU during the COVID-19 pandemic. While there was no significant difference in pH and HCO Conclusion: Higher HbA1c levels of newly diagnosed patients presenting with DKA may be associated with delayed admission to the health institutions due to COVID-19 and the length of insulin-free periods compared to pre-diagnosed patients with T1DM. In conclusion, our results, emphasize the importance of physician's and family's awareness of the symptoms of diabetes in terms of early diagnosis and prevention of DKA during public health measures due to COVID-19.
Language	English
Publishing date	2022-10-20
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	3031921-3
ISSN	2536-4553 ; 2148-4902
ISSN (online)	2536-4553
ISSN	2148-4902
DOI	10.14744/nci.2022.09634
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Article: Presentations, Complications, and Challenges Encountered During Management of Type 1 Diabetes in Egyptian Children During COVID-19 Pandemic: A Single-Center Experience.

Abdou, Marise / Hassan, Mona M / Hassanein, Samah A / Elsebaie, Eman H / Shamma, Radwa A

Frontiers in endocrinology

2022 Volume 13, Page(s) 814991

Abstract: ... from the first and second COVID-19 waves with that of the pre-COVID-19 period and describe the challenges ... University, during the first and second COVID-19 waves. It also included data collected from the pre-COVID-19 ... of COVID-19, such as fever (29.5%), respiratory manifestations (7.2%), and gastrointestinal symptoms (14.7 ...

Abstract	Background: The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant challenges pertaining to the management of children and adolescents with type 1 diabetes (T1D). Issues such as fear of infection and lockdown measures have resulted in delayed and more severe clinical presentations of this disease. Objectives: This study aimed at reporting the frequency and severity of diabetic ketoacidosis (DKA) and the rate of DKA complications in children with diabetes who presented to the emergency unit during COVID-19 pandemic. Furthermore, the purpose of this study was to compare the data collected from the first and second COVID-19 waves with that of the pre-COVID-19 period and describe the challenges encountered during disease management. Methods: This cross-sectional study included all children and adolescents with T1D who presented to the emergency department at Abo El Rish Children's Hospital, Cairo University, during the first and second COVID-19 waves. It also included data collected from the pre-COVID-19 period. Demographic and clinical data, investigations, and management details were collected from the patients' medical records. Results: Three hundred twenty-four Egyptian children and adolescents diagnosed with T1D were recruited. One hundred forty patients (43.2%) presented with severe DKA, and approximately 66% were newly diagnosed with T1D. The participants presented with manifestations suggestive of COVID-19, such as fever (29.5%), respiratory manifestations (7.2%), and gastrointestinal symptoms (14.7%). Thirty-seven patients were tested for severe acute respiratory syndrome coronavirus 2 infection using nasopharyngeal swabs, and four patients tested positive. Around 18% of patients developed hypokalemia during disease management. A comparison between these data and the data from previous years revealed that there was a significant increase in the number of newly diagnosed cases with more severe DKA at presentation and a higher frequency of development of hypokalemia during both COVID-19 waves. Conclusion: An increase in the frequency of newly diagnosed cases was identified during the first and the second COVID-19 waves compared with the pre-COVID-19 period. The patients presented with more severe DKA, probably due to a more delayed presentation. The frequency of hypokalemia development was also significantly higher, and the severity of DKA was associated with a longer ICU admission. Further studies are required to establish a definitive link between the COVID-19 pandemic and the severity of presentation.
MeSH term(s)	Adolescent ; COVID-19/complications ; COVID-19/epidemiology ; Child ; Communicable Disease Control ; Cross-Sectional Studies ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/epidemiology ; Diabetes Mellitus, Type 1/therapy ; Egypt/epidemiology ; Humans ; Pandemics
Language	English
Publishing date	2022-03-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2022.814991
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Article ; Online: Epidemiology, clinical presentation and management of COVID-19 associated Mucormycosis: A single center experience from Pune, Western India.

Dravid, Ameet / Kashiva, Reema / Khan, Zafer / Bande, Balasaheb / Memon, Danish / Kodre, Aparna / Potdar, Prashant / Mane, Milind / Tamboli, Asir / Pawar, Vishal / Patil, Dattatraya / Banerjee, Debashis / Bhoite, Kailas / Shinde, Akshay / Pharande, Reshma / Kalyani, Suraj / Raut, Prathamesh / Bapte, Madhura / Saldanha, Charlotte /

Chandak, Dinesh / Ajani, Fouzia / Mehta, Anshul / Reddy, M Sateesh / Bhayani, Krushnadas / S S, Laxmi / P D, Vishnu / Srivastava, Shipra / Khandelwal, Shubham / More, Sailee / Shakeel, Atif / Pawar, Mohit / Nande, Pranava / Harshe, Amol / Kadam, Sagar / Halikar, Sudhir / Kamal, Nudrat / Andrabi, Danish / Bodhale, Sachin / Raut, Akshay / Gawande, Pushkar / Bhandari, Ankush / Wasmatkar, Nilesh / Sarkar, Adnanali / Chandrashekhar, Sangeeta / Butiyani, Pallavi / Akhade, Geetanjali / Abnave, Aditi / Raman, Chandrashekhar / Basade, Siraj / Mahajan, Uma / Joshi, Gaurav / Mane, Dileep

medRxiv

Abstract: ... were diabetic with 30% being newly diagnosed at the time of COVID-19 admission and 89% having ... p=0.017), presence of orbital symptoms(p=0.002), presence of diabetic ketoacidosis(p=0.011) and ... Background: The second COVID-19 wave in India, triggered by the Delta variant,has been associated ...

Abstract	Background: The second COVID-19 wave in India, triggered by the Delta variant,has been associated with an unprecedented increase in cases of COVID-19 associated Mucormycosis(CAM), mainly Rhino-orbito-cerebral mucormycosis(ROCM).The primary reason appears to be an unusual alignment of multiple risk factors in patients like prevalence of hypoxia, uncontrolled diabetes mellitus, indiscriminate use of steroids, high iron levels and immune dysfunction. Methods: This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, Western India between 1st April 2020 and 1st August 2021 to identify patients admitted with CAM. The primary endpoint was incidence of all cause mortality due to CAM. Secondary outcomes studied were need for mechanical ventilation and intensive care unit(ICU) admission. Baseline and time dependent risk factors significantly associated with death due to CAM were identified by Relative risk estimation. Results: 59 patients were diagnosed with Mucormycosis at NHRC (58 ROCM, 1 Renal (disseminated) mucormycosis). Median age of the cohort was 52(IQR: 41,61) years and it included 20.3% females. Median duration from first positive COVID-19 RT PCR test to diagnosis of Mucormycosis was 17(IQR: 12,22) days. 90% patients were diabetic with 30% being newly diagnosed at the time of COVID-19 admission and 89% having uncontrolled sugar level (HbA1c > 7%). All patients were prescribed steroids during treatment for COVID-19. 56% patients were prescribed steroids for non-hypoxemic, mild COVID (irrational steroid therapy) while in 9%, steroids were indicated but were prescribed in inappropriately high dose. Majority of the patients were treated with a combination of surgical debridement(94%), intravenous Amphotericin B(91%) and concomitant oral Posoconazole therapy(95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% (15 patients) died. On Relative risk analysis, CT severity score during COVID-19 admission ≥18 (p=0.017), presence of orbital symptoms(p=0.002), presence of diabetic ketoacidosis(p=0.011) and cerebral involvement by Mucor(p=0.0004) were associated with increased risk of death. Duration of Amphotericin B therapy of ≥ 21 days was associated with statistically significant reduction in mortality(p=0.002). Conclusions: CAM is an uncommon, rapidly progressive, angioinvasive, opportunistic fungal infection which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.
Keywords	covid19
Language	English
Publishing date	2021-09-22
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.09.15.21263622
Database	COVID19

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Article: COVID-19 and Diabetic Ketoacidosis: A Single Center Experience.

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Article ; Online: Increased severity of presentation signs in children with newly diagnosed Type 1 Diabetes during the COVID-19 pandemic: A tertiary center experience.

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Article ; Online: Glycemic variability and time in range among children with type 1 diabetes on insulin pump during the Covid-19 pandemic in Egypt; single center experience.

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Article: Increase in the Number of Pediatric New-Onset Diabetes and Diabetic Ketoacidosis Cases During the COVID-19 Pandemic.

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Article ; Online: Does the severity of diabetic ketoacidosis in children with type 1 diabetes change during the COVID-19 pandemic? A single-center experience from a pediatric intensive care unit.

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Article: Presentations, Complications, and Challenges Encountered During Management of Type 1 Diabetes in Egyptian Children During COVID-19 Pandemic: A Single-Center Experience.

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Article ; Online: Epidemiology, clinical presentation and management of COVID-19 associated Mucormycosis: A single center experience from Pune, Western India.

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