DOES THE INCIDENCE OF DIABETIC KETOACIDOSIS IN

PATIENTS WITH TYPE 1 DIABETES MELLITUS DIFFER

DURING COVID-19 PANDEMIC?
Syarifah Nursyazana Syed Ridzuan1, Amira Yasmin Mohamed Zaini1, Alexis Anandas Lordudass2, Azriyanti Anuar Zaini2, Nurshadia Samingan2.
1. Undergraduate Study (MBBS), University Malaya
2. Paediatric Endocrine Unit, Department of Paediatrics, University Malaya Medical Centre
Department of Paediatrics, Faculty of Medicine, University Malaya.

INTRODUCTION

• The pandemic COVID-19 has resulted in healthcare chaos worldwide. Due to surge of critically ill patients with COVID-19, the care of non-COVID-19
cases was less prioritised.
• Studies showed that the delay in seeking medical attention contributed to the increase in the number of diabetic ketoacidosis (DKA) during the
pandemic.
• This study seeks to provide insights into the relationship between COVID-19 and the incidence of diabetic ketoacidosis (DKA) in Type 1 diabetes
mellitus patients.

STUDY OBJECTIVE
• To compare the incidence of DKA and its severity prior and during/post COVID-19 pandemic.

METHODS
• This is a retrospective study involving both the newly diagnosed or known T1DM patients aged 1 to less than 18 years old who presented to University
Malaya Medical Centre (UMMC) with DKA.
• Data collection encompassed the period from September 2017 to August 2022. Information regarding demographic details, DKA presentation, recurrence,
severity, PICU admission, duration of recovery, COVID-19 status, duration from symptoms to presentation, and biochemical values was recorded.
• SPSS version 26 was used to perform the data analyses. Data were presented as frequency (n) with percentage (%) for categorical data and mean (± SD)
or median (interquartile range). Differences between groups were calculated using Mann-Whitney U test, Pearson Chi-Square test or Fisher Exact test with
significance p-value at < 0.05

RESULTS:

• Seventy two patients fulfilled the criteria to be included in the study.

• A total of 96 DKA cases were reported, with 50 (69%) of them comprising the patients with newly diagnosed T1DM.
• Both periods showed an equal number of DKA cases, with 48 cases each.(TABLE 1)
• There was a slight increase in the incidence of DKA cases in the newly diagnosed T1DM during the COVID-19 period (21 vs 23, p=0.92)(FIGURE 1)
• Increment was seen in the total number of severe DKA cases during the COVID-19 period. (25 vs 19, p= 0.347), although not statistically significant
(TABLE 1&FIGURE 2)
• Almost similar numbers of recurrent DKA occurred during these two periods (27 vs 25, p=0.414) (FIGURE 1 & TABLE 2).The numbers with severe DKA
almost doubled during COVID-19 period(9 vs 5, p=0.523) (TABLE 2).
• There were more cases of severe DKA observed in the newly diagnosed T1DM patients with lower pH levels (7.05 vs. 7.12, p=0.417) and longer recovery
duration compared to previously (48 hours vs. 36 hours, p=0.150) (TABLE 1), however these findings were insignificant statistically.
• There were 3 newly diagnosed patients who were positive for COVID-19 (category 2b) presented with moderate to severe DKA.

Demographic Pre COVID-19 Post COVlD-19 DKA Pre COVID Post COVlD P value
P value
/clinical data n(48) n(48)
Incidence (n=96)
Age at DKA New Type 1 21 (44%) 23 (48%) 0.414
11.0 (6.3-13.0) 12.0 (8.0-14.8) 0.106
(years) Known Type 1 27 (56%) 25 (52%)

Male gender 23 (47.9) 20 (41.7) 0.538 Severe DKA

14 (74%) 16 (62%) 0.523
• New T1DM
Race 5 (26%) 9 (38%)
• Known T1DM
Malay 18 (37.5) 25 (52.1) Total
Chinese 8 (16.7) 9 (18.8) 0.394 19 25
India 17 (35.4) 11 (22.9)
Others 5 (10.4) 3 (6.3)
Table 2: Comparison between DKA in newly diagnosed T1DM and known type 1 DM
Blood glucose at patients
presentation 25.9 (20.7-30.0) 26.4 (20.8-31.5) 0.910
(mmol/L)

Blood ketone at 27 25
presentation 4.70 (4.00-5.80) 5.60 (3.78-7.00) 0.173 23
(mmol/L) 21

Blood pH 7.17 (7.00-7.26) 7.09 (6.94-7.20) 0.146 Figure 1: Types of patients with
DKA
Severe DKA 19 (39.6) 25 (50.0) 0.347

PICU admission 17 (35.4) 20 (41.7) 0.529

For newly diagnosed T1DM

Number of cases 27(44) 30 (56)

DKA 21 (78) 23 (77) 0.92

25
Blood pH 7.12 (7.00-7.25) 7.05 (6.95-7.20) 0.417
19
Duration to 15
36 (12-40) 48 (13-52) 0.15 15
recovery (hours) 13 Figure 2: DKA severity
9
COVID positive 3(0.06)

TABLE 1: Demographic and clinical data of patients with DKA at pre and post COVID-19
period

CONCLUSION:

• There is no significant difference in terms of incidence and severity of DKA between the pre and post-COVID periods.
• Despite that, it is observed that there is an increase in the incidence of severe DKA cases during the post-COVID period, which necessitated more PICU
admissions and longer recovery time.
• These findings could be attributed to the limited healthcare access experienced during the pandemic, which resulted in delayed presentation and initiation of
treatment.

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