Unmasking the escalation: a comparative analysis of diabetic ketoacidosis severity before and during the COVID-19 pandemic in a Tunisian pioneer study

ABSTRACT

Background

The severity of diabetic ketoacidosis (DKA) at diagnosis increased during the global COVID-19 pandemic. This study aimed to analyze the impact of the pandemic on the clinical and biological severity of DKA in patients with new-onset diabetes mellitus (DM) in Tunisia.

Research design and methods

The study included patients hospitalized for new-onset DKA 2 years prior and 2 years during the COVID-19 pandemic. Data was collected retrospectively, and DKA severity was classified based on biological parameters like potential of hydrogen (pH) and HCO3-.

Results

The results showed that DKA was more severe during COVID-19, as evidenced by lower potential of hydrogen (pH) (p = 0.006), and serum bicarbonate (HCO3-) levels (p = 0,005). Despite the higher severity of DKA was higher during COVID-19, intensive care unit hospitalizations remained equivalent (p = 0.359). The prevalence of hyponatremia was also higher during COVID-19 (p = 0.024).

Conclusion

The findings suggest that delayed diagnosis and COVID-19 May contribute to the increased severity of DKA and electrolyte imbalance during the pandemic. Further research is needed to better understand the underlying mechanisms and develop appropriate strategies to address this issue.

KEYWORDS:

• Diabetic ketoacidosis
• diabetes mellitus
• severity
• COVID-19
• pandemic

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to thank Dr Hamdi Frikha who played a role in validating the statistical analysis.

Ethics

Written and informed consent was obtained from the patients for publication of the submitted article. The anonymity and data confidentiality of the patients’ data were respected. Approval from the Ethical Committee of University of Medicine of Sousse was obtained under the assigned number 4935/2023.

Data availability statement

The data that support the findings of this study are available from the corresponding author, GORCHANE Asma, upon reasonable request.

Author contributions

Gorchane Asma and Ach Taieb drafted the manuscript. All authors have contributed significantly to this work, providing substantial intellectual input, and have thoroughly reviewed and approved the final manuscript.

Additional information

Funding

This paper was not funded.