Background

Diabetic ketoacidosis (DKA) has been reported to be increasing in frequency during the COVID-19 pandemic. We aimed to examine the rates of DKA hospital admissions and the patient demographics associated with DKA during the pandemic compared with in prepandemic years.

Methods

Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, we extracted all emergency hospital admissions in England coded with DKA from March 1 to June 30, 2020 (first wave of the pandemic), July 1 to Oct 31, 2020 (post-first wave), and Nov 1, 2020, to Feb 28, 2021 (second wave), and compared these with DKA admissions in the equivalent periods in 2017–20. We also examined baseline characteristics, mortality, and trends in patients who were admitted with DKA.

Findings

There were 8553 admissions coded with DKA during the first wave, 8729 during the post-first wave, and 10 235 during the second wave. Compared with preceding years, DKA admissions were 6% (95% CI 4–9; p<0·0001) higher in the first wave of the pandemic (from n=8048), 6% (3–8; p<0·0001) higher in the post-first wave (from n=8260), and 7% (4–9; p<0·0001) higher in the second wave (from n=9610). In the first wave, DKA admissions reduced by 19% (95% CI 16–21) in those with pre-existing type 1 diabetes (from n=4965 to n=4041), increased by 41% (35–47) in those with pre-existing type 2 diabetes (from n=2010 to n=2831), and increased by 57% (48–66) in those with newly diagnosed diabetes (from n=1072 to n=1681). Compared with prepandemic, type 2 diabetes DKA admissions were similarly common in older individuals and men but were higher in those of non-White ethnicities during the first wave. The increase in newly diagnosed DKA admissions occurred across all age groups and these were significantly increased in men and people of non-White ethnicities. In the post-first wave, DKA admissions did not return to the baseline level of previous years; DKA admissions were 14% (11–17) lower in patients with type 1 diabetes (from n=5208 prepandemic to n=4491), 30% (24–36) higher in patients with type 2 diabetes (from n=2011 to n=2613), and 56% (47–66) higher in patients with newly diagnosed diabetes (from n=1041 to n=1625). During the second wave, DKA admissions were 25% (22–27) lower in patients with type 1 diabetes (from n=5769 prepandemic to n=4337), 50% (44–56) higher in patients with type 2 diabetes (from n=2608 to n=3912), and 61% (52–70) higher in patients with newly diagnosed diabetes (from n=1234 to n=1986).

Interpretation

Our results provide evidence for differences in the numbers and characteristics of people presenting with DKA during the COVID-19 pandemic compared with in the preceding 3 years. Greater awareness of risk factors for DKA in type 2 diabetes and vigilance for newly diagnosed diabetes presenting with DKA during the COVID-19 pandemic might help mitigate the increased impact of DKA.

Funding

None.

中文翻译：

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在 COVID-19 大流行之前和期间英国糖尿病患者因糖尿病酮症酸中毒紧急入院的时间趋势：一项基于人群的研究

背景

据报道，在 COVID-19 大流行期间，糖尿病酮症酸中毒 (DKA) 的发病率正在增加。我们的目的是检查与大流行前几年相比，大流行期间 DKA 住院率和与 DKA 相关的患者人口统计数据。

方法

使用一个全面的、多民族的、国家数据集，即二次使用服务存储库，我们提取了 2020 年 3 月 1 日至 6 月 30 日（第一波大流行）、2020 年 7 月 1 日至 10 月 31 日期间使用 DKA 编码的英格兰所有急诊住院人数（第一波后）和 2020 年 11 月 1 日至 2021 年 2 月 28 日（第二波），并将这些与 2017-20 年同期的 DKA 入学人数进行比较。我们还检查了因 DKA 入院的患者的基线特征、死亡率和趋势。

发现

第一波期间使用 DKA 编码的入院人数为 8553 人，第一波之后为 8729 人，第二波期间为 10235 人。与前几年相比，第一波大流行期间（n=8048）DKA 入院率高 6%（95% CI 4-9；p<0·0001），6%（3-8；p<0· 0001) 在第一波后更高（从 n=8260），在第二波（从 n=9610）中更高 7% (4–9；p<0·0001)。在第一波中，既往患有 1 型糖尿病的患者（从 n=4965 到 n=4041）的 DKA 入院率降低了 19% (95% CI 16–21)，在那些患者中增加了 41% (35–47) 2 型糖尿病患者（从 n=2010 增至 n=2831），新诊断糖尿病患者（从 n=1072 增至 n=1681）增加了 57% (48–66)。与疫情前相比，2 型糖尿病 DKA 入院在老年人和男性中同样常见，但在第一波期间非白人种族中更高。新诊断的 DKA 入院人数增加发生在所有年龄组，并且在男性和非白人种族中显着增加。后一波，DKA录取并没有回到往年的基线水平；1 型糖尿病患者的 DKA 入院率降低 14% (11-17)（从大流行前 n=5208 到 n=4491），2 型糖尿病患者的 DKA 入院率高 30%（24-36）（从 n=2011 到 n =2613)，并且在新诊断的糖尿病患者中高出 56% (47–66)（从 n=1041 到 n=1625）。在第二波期间，1 型糖尿病患者的 DKA 入院率降低了 25% (22–27)（从大流行前的 n=5769 减少到 n=4337），

解释

我们的结果提供了证据，证明与过去 3 年相比，在 COVID-19 大流行期间出现 DKA 的人数和特征存在差异。在 COVID-19 大流行期间，提高对 2 型糖尿病 DKA 危险因素的认识以及对新诊断的糖尿病并发 DKA 的警惕可能有助于减轻 DKA 增加的影响。

资金

没有任何。