key: cord-0693876-hnk7zi77
authors: Lopez‐Huamanrayme, Eddy; Cordova‐Huancas, Claudia; Garate‐Chirinos, Dioni; Espinoza‐Morales, Frank; Pasquel, Francisco
title: Diabetic ketoacidosis and high mortality among patients with coronavirus disease 2019 in a Peruvian hospital
date: 2021-11-23
journal: J Diabetes Investig
DOI: 10.1111/jdi.13704
sha: 1908b166d0f44442c51cb801d16b398c0210d3e2
doc_id: 693876
cord_uid: hnk7zi77

nan

Among patients with diabetic ketoacidosis (DKA) treated with standard of care continuous insulin infusion, the mortality reported was up to 30% 1 , significantly higher compared with pre-pandemic data.

There are limited data from developing countries, such as Peru, which has the highest mortality per million inhabitants in the world. Through a virtual platform, we extracted individual data from patients admitted to Hospital Nacional Alberto Sabogal Sologuren (Callao, Peru) between March and December 2020 with COVID-19 and DKA and/or hyperglycemic hyperosmolar state, to obtain clinical information and outcomes. A total of 31 patients were included, 61.3% were men, the median age was 56 years, 41.9% of patients showed new diabetes and we did not have any patients with type 1 diabetes, the rest of the patients had type 2 diabetes. More than 80% of patients were diagnosed with DKA, and no patient with isolated hyperglycemic hyperosmolar state was found. Other clinical and laboratory characteristics are shown in Table 1 .

Approximately seven out of 10 patients presenting with DKA and COVID-19 died (74.2% mortality). As expected, mortality was highest among older patients, as recently reported 1,2 . In the USA in a large cohort of patients admitted for DKA, the mortality associated with COVID-19 was higher compared with those without COVID-19 (30% vs 5%) in the same study period 1 , another study found a mortality rate of 50% 2 , but in the UK 3 , the reported mortality rate was 5.7%.

We found a large proportion of new diabetes (41.9%), which is higher than other populations 2,3 . This might be related to a high prevalence of underdiagnosed prediabetes (22.4%) and diabetes mellitus (2.8%) in Peru 4 .

Glycemia on admission and laboratory markers of severe COVID-19 (ferritin, Creactive protein, leukocyte count, etc.) were high (Table 1) , which could explain the high mortality. However, in Peru, it could also be due to the negative impact of the gaps in our health system. 

Characteristics of and mortality associated with diabetic ketoacidosis among US patients hospitalized with or without COVID-19

Letter to the editor: unexpected high mortality in COVID-19 and diabetic ketoacidosis

Protracted ketonaemia in hyperglycaemic emergencies in COVID-19: a retrospective case series

Prevalence of diabetes and impaired fasting glucose in Peru: report from PERUDIAB, a national urban population-based longitudinal study

The Authors