Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Diabetes Metab Syndr. 2020 Nov-Dec;14(6):1563-1569. doi: 10.1016/j.dsx.2020.08.015. Epub 2020 Aug 18.


Background and aim: To conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome).

Methods: PubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria.

Results: Of the 110 patients, 91 (83%) patients had isolated DKA while 19 (17%) had DKA/HHS. The majority of the patients were male (63%) and belonged to black ethnicity (36%). The median age at presentation ranged from 45.5 to 59.0 years. Most of the patients (77%) had pre-existing type 2 diabetes mellitus. Only 10% of the patients had newly diagnosed diabetes mellitus. The median blood glucose at presentation ranged from 486.0 to 568.5 mg/dl, being higher in patients with DKA/HHS compared to isolated DKA. The volume of fluid replaced in the first 24 h was higher in patients with DKA/HHS in contrast to patients with DKA alone. The in-hospital mortality rate was 45%, with higher mortality in the DKA/HHS group than in the isolated DKA group (67% vs. 29%). pH was lower in patients who had died compared to those who were discharged.

Conclusion: DKA in COVID-19 patients portends a poor prognosis with a mortality rate approaching 50%. Differentiating isolated DKA from combined DKA/HHS is essential as the latter represents nearly one-fifth of the DKA cases and tends to have higher mortality than DKA alone.

Keywords: COVID-19; Diabetic ketoacidosis; Hyperglycemic hyperosmolar syndrome; Subcutaneous insulin therapy.

Publication types

  • Systematic Review

MeSH terms

  • Blood Glucose / metabolism*
  • COVID-19 / blood
  • COVID-19 / epidemiology*
  • COVID-19 / therapy
  • Diabetic Ketoacidosis / blood
  • Diabetic Ketoacidosis / epidemiology*
  • Diabetic Ketoacidosis / therapy
  • Humans
  • Hyperglycemic Hyperosmolar Nonketotic Coma / blood
  • Hyperglycemic Hyperosmolar Nonketotic Coma / epidemiology*
  • Hyperglycemic Hyperosmolar Nonketotic Coma / therapy
  • Insulin / therapeutic use


  • Blood Glucose
  • Insulin