Short term follow-up of patients presenting with acute onset diabetes and diabetic ketoacidosis during an episode of COVID-19

Abstract

Background and aims: Acute onset diabetes and diabetic ketoacidosis (DKA) can be precipitated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in individuals with no history of diabetes. However, data regarding the follow-up of these individuals are scarce.

Methods: Three patients (data of two patients already published) with acute onset diabetes and DKA, precipitated by coronavirus disease 2019 (COVID-19), were followed for 14 weeks to assess the behavior of the diabetes. Detailed history, anthropometry, laboratory investigations, imaging studies, clinical course and outcomes were documented.

Results: Three individuals developed symptoms suggestive of SARS CoV-2 infection. After a few days, they were detected to have COVID-19 pneumonia, based on reverse transcription-polymerase chain reaction (RT-PCR) assay and chest imaging. In the meantime, they also developed acute onset diabetes and DKA, which were precipitated by COVID-19. They responded well to treatment, including intravenous fluids and insulin. After around one week, they were transitioned to multiple shots of subcutaneous insulin. After about 4-6 weeks, their insulin requirement diminished and oral antihyperglycemic drugs were initiated. At the last follow-up (14 months), they had controlled glycemia with oral antihyperglycemic medicines.

Conclusions: COVID-19 can induce acute onset diabetes and DKA in some individuals with no history of diabetes. These features resemble type 1 diabetes. However, after 4-6 weeks, their requirement for exogenous insulin diminishes and respond to oral antihyperglycemic medications. Long term follow up is required to further understand the type of diabetes induced by SARS CoV-2 infection in these individuals.

Keywords: COVID-19; Coronavirus; DKA; Diabetic ketoacidosis; SARS CoV-2.

Fig. 1

Follow-up of patients with acute onset diabetes and diabetic ketoacidosis precipitated by SARS CoV-2 infection. At the onset, diabetes resembles type 1 diabetes, characterized by acute onset and DKA as presenting feature. At around 4–6 weeks, exogenous insulin requirement diminishes and glycemia can be controlled with oral-antihyperglycemic medicines (metformin ± dipeptidyl peptidase-4 inhibitor).