Table 1 Summary of the characteristics of the included studies with evidence on diabetic ketoacidosis and SARS-CoV-2 (n = 68 studies), 2019–2021
From: Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis
Author, year, study location | Study design, setting | Age (years)b | Male, n (%) | BMI (kg/m2)b | Ethnicitya | Type of diabetes | Use of SGLT2 inhibitors | Biochemical parameters at presentationb | NOS score; and Treatment outcome | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Blood glucose (mg/dl) | HbA1c (%) | pH | Bicarbonate (mmol/l) | Anion gap (mEq/l) | |||||||||
Albuali et al. 2021 [8], Saudi Arabia | Retrospective case report, single centre | 7 | 0 (0) | Not reported | 1 Arab | 1 Newly diagnosed | No | 555 | 10.3 | 7.10 | 10 | 23 | (NOS, 6) 1 survived |
Alfishawy et al. 2021 [9], Egypt | Retrospective case report, single centre | 17 | 1 (100) | Not reported | 1 Arab | 1 Newly diagnosed | No | 566 | 14.7 | 6.8 | Not reported | Not reported | (NOS, 5) 1 survived |
Ali et al. 2021 [10], Qatar | Retrospective case report, single centre | 53 | 1 (100) | Not reported | 1 Bengali | 1 Newly diagnosed | No | 295.2 | 6.9 | 6.831 | 5 | 35 | (NOS, 6) 1 died |
Alizadeh et al. 2021 [11], United States | Retrospective case report, single centre | 1.3 | 1 (100) | Not reported | Not reported | 1 Newly diagnosed | No | 805 | 9.5 | 7.0 | 4 | 40 | (NOS, 6) 1 survived |
Al-Naami et al. 2020 [12], Saudi Arabia | Retrospective case report, single centre | 46 | 1 [100] | 27 | 1 Arab | 1 Newly diagnosed | No | 657 | 13.5 | 7.4 | 29 | 26 | (NOS, 5) 1 died |
Alsadhan et al. 2020 [13], Saudi Arabia | Retrospective case series, single centre | 47 (42–62.5) | 3 (60) | 29.4 (26.8–29.4) | 5 Arab | 2 Pre-existing T2DM 1 Pre-existing T1DM 2 Newly diagnosed | No | 491 (360–664) | 11.3 (10.4–14.8) | 7.14 (6.97–7.27) | 12.5 (8.5–14.1) | 25 (19.5–26) | (NOS, 6) 4 survived 1 died |
Añazco et al. 2021 [14], Peru | Retrospective case report, single centre | 41 | 0 (0) |  > 30 | 1 Hispanic | 1 Pre-existing T2DM | No | 500 | Not reported | 7.29 | 20 | Not reported | (NOS, 5) 1 died |
Amesfoort et al. 2021 [71], The Netherlands | Retrospective case report, single centre | 21 | 0 (0) | Not reported | 1 White (Caucasian) | Not reported | No | 84.6 | Not reported | 7.34 | 8.7 | 23 | (NOS, 6) 1 survived |
Armeni et al. 2020 [15], United Kingdom | Retrospective case series, multicentre | 57 [48–64] | 7 (63.6) | 24·7 (21·3–28·5) | 5 Black 1 Asian 3 White (Caucasian) 2 Mixed | 2 Pre-existing T1DM 9 Pre-existing T2DM | No | 486 (396–558) | 12.4 (10·7–14·2) | 7.2 (6.9–7.3) | 11.8 (7.8–15.4) | 14.8 (10.4–20.5) | (NOS, 8) 10 survived 1 died |
Batista et al. 2021 [16], Brazil | Retrospective case report, single centre | 56 | 1 (100) | 26.4 | 1 Hispanic | 1 Pre-existing T2DM | 1 Yes | 118 | 7.2 | 7.28 | 8.9 | 24.1 | (NOS, 6) 1 survived |
Cavalcanti et al. 2020 [17], United states | Retrospective case report, single centre | 23 | 1 (100) | Not reported | Not reported | 1 Newly diagnosed | No | 1384 | Not reported | 7.0 | Not reported | Not reported | (NOS, 6) 1 died |
Chamorro-Pareja et al. 2020 [18], United States | Retrospective cohort, single centre | 59 (42.3–70) | 32 (64) | 27.15 (23.2–33) | 15 Black 16 Hispanic 8 Other 3 White (Caucasian) 1 Asian 7 Unknown | 6 Pre-existing T1DM 44 Pre-existing T2DM 8 Newly diagnosed | 2 Yes | 506 (252–1485) | HbA1c ≥ 8 (n = 30) HbA1c < 8 (n = 4) and HbA1c unknown (n = 16) | Not reported | Not reported | 28.1 (14.3–41.2) | (NOS, 6) 24 survived 25 died 1 hospitalized |
Chan et al. 2020 [19], United States | Retrospective case reports, single centre | 50 (33.2–62) | 6 (100) | 24.7 (23.9–37.6) | 3 Black 3 Hispanic | 5 Pre-existing T2DM 1 Newly diagnosed | No | 1014 (663–1116) | 12.7 (11.2–13.5) | 7.05 (6.83–7.21) | 7.3 (5.7–9.6) | 29 (27–32.2) | (NOS, 6) 2 survived 4 died |
Chee et al. 2020 [20], Singapore | Retrospective case report, single centre | 37 | 1 (100) | 22.6 | 1 Asian | 1 Newly diagnosed | No | 715 | 14.2 | 7.28 | 12 | 30 | (NOS, 6) 1 survived |
Croft et al. 2020 [21], United States | Retrospective case reports, single centre | 55 (41.5–60) | 2 (40) | 29.1 (20.6–33.6) | 1 Black 3 Hispanic | 5 Pre-existing T2DM | No | 399 (284–848) | 11.3 (9.6–13.4) | 7.1 (7.0–7.2) | Not reported | 21 (18–23) | (NOS, 6) 3 survived 1 died 1 hospitalized |
Daniel et al. 2020 [22], India | Retrospective case report, single centre | 15 | 0 (0) | 19 | 1 Indian | 1 Newly diagnosed | No | 414 | 13.5 | 6.9 | 2 | Not reported | (NOS, 5) 1 survived |
Dey et al. 2021 [23], Maldives | Retrospective case reports, single centre | 65.5 (53–65.5) | 2 (100) | Not reported | 2 Asian | 2 Pre-existing T2DM | No | 1084 (626–1084) | 9.8 (6.6–9.8) | Not reported | Not reported | Not reported | (NOS, 5) 2 survived |
Ebekozien et al. 2021 [24], United States | Retrospective cohort, multicentre |  ≤ 19 = (n = 30) AND  > 19 = (n = 25) | 23 (41.8) |  > 30 (n = 9) | 30 Black 15 Hispanic 10 White (Caucasian) | 44 Pre-existing T1DM 11 Newly diagnosed | No | Not reported | 11.1 (9–11.1) | Not reported | Not reported | Not reported | (NOS, 8) 51 survived 4 died |
Emara et al. 2020 [25], Saudi Arabia | Retrospective case report, single centre | 51 | 1 (100) | 21 | 1 Arab | 1 Pre-existing T2DM | No | 592 | 7.8 | 7 | Not reported | Not reported | (NOS, 5) Not reported |
Ghosh et al. 2021 [26], India | Retrospective case report, single centre | 60 | 1 (100) | Not reported | 1 Indian | 1 Newly diagnosed | No | 540 | 5.1 | 7.20 | 13 | 18 | (NOS, 6) 1 survived |
Goldman et al. 2020 [27], United Kingdom | Retrospective case reports, single centre | 50.5 (40.5–76.2) | Not reported | Not reported | 1 White (Caucasian) 2 Asian 1 Black | 3 Pre-existing T2DM 1 Newly diagnosed | 1 Yes | 378 (346–450) | 10.8 (9.5–10.8) | 7.17 (7.10–7.26) | 10 (7.5–14.8) | Not reported | (NOS, 7) 1 survived 2 died 1 hospitalized |
Gorthi et al. 2021 [28], United States | Retrospective case series, single centre | 65 (61.5–77) | 2 (40) | 28.6 (24.3–31.1) | 4 Black 1 White (Caucasian) | 3 Pre-existing T1DM 2 Pre-existing T2DM | 1 Yes | 587 (370.5–723) | 8.9 (8.1–10.4) | 7.31 (7.11–7.33) | 16 (7–18.5) | 26 (20–28.5) | (NOS, 6) 4 survived 1 died |
Haider et al. 2020 [29], United States | Retrospective case report, single centre | 46 | 0 (0) | Not reported | Not reported | 1 Pre-existing T1DM | No | 590 | Not reported | Not reported | Not reported | 18 | (NOS, 6) 1 survived |
Hawkes et al. 2021 [30], United States | Retrospective case reports, single centre | 6 [3–6] | 1 (50) | Not reported | Not reported | 2 Newly diagnosed | No | Not reported | Not reported | 7.17 (7.1–7.17) | 10.1 (10–10.1) | Not reported | (NOS, 6) 2 survived |
Heaney et al. 2020 [31], United States | Retrospective case report, single centre | 54 | 1 (100) | 42.56 | Not reported | 1 Newly diagnosed | No | 463 | Not reported | 7.193 | 9.9 | 31 | (NOS, 6) 1 survived |
Heidarpour et al. 2021 [32], Iran | Retrospective case report, single centre | 36 | 1 (100) | Not reported | 1 Persian | 1 Newly diagnosed | No | 500 | Not reported | 7 | 11 | Not reported | (NOS, 6) 1 survived |
Hollstein et al. 2020 [33], Germany | Retrospective case report, single centre | 19 | 1 (100) | Not reported | 1 White (Caucasian) | 1 Newly diagnosed | No | 552 | 16.8 | 7.1 | Not reported | Not reported | (NOS, 6) 1 survived |
Howard et al. 2021 [34], United States | Retrospective case reports, single centre | 14.5 (12–14.5) | 1 (50) | Not reported | Not reported | 2 Newly diagnosed | No | 518 (337–518) | 10.9 (10.8–10.9) | 6.91 (6.84–6.91) | 5 (3.7–5) | 27.5 (25–27.5) | (NOS, 7) 2 survived |
Ishii et al. 2021 [35], Japan | Retrospective case report, single centre | 33 | 0 (0) | Not reported | 1 Asian | 1 Newly diagnosed | No | 638 | 15.7 | 6.74 | 4.8 | 27.2 | (NOS, 6) 1 survived |
Kabashneh et al. 2020 [36], United States | Retrospective case report, single centre | 54 | 1 (100) | Not reported | Not reported | 1 Pre-existing T1DM | No | 1100 | Not reported | 6.79 | 4 | 46 | (NOS, 6) 1 survived |
Kaur et al. 2020 [37], United States | Retrospective case report, single centre | 43 | 1 (100) | Not reported | Not reported | 1 Pre-existing T2DM | No | 948 | Not reported | 6.96 | Not reported | 27 | (NOS, 6) 1 died |
Kim et al. 2020 [38], South Korea | Retrospective case reports, single centre | 65.5 (59–65.5) | 1 (50) | Not reported | 2 Asian | 2 Pre-existing T2DM | No | 672 (655–672) | 12 (11.4–12) | 7.381 | 18.1 | Not reported | (NOS, 6) 1 died 1 hospitalized |
Kuchay et al. 2020 [39], India | Retrospective case reports, single centre | 34 (30–34) | 3 (100) | 27.3 (26.2–27.3) | 3 Indian | 3 Newly diagnosed | No | 582 (555–582) | 12 (9.6–12) | 7.21 (7.07–7.21) | 13 (6.1–13) | 16.2 (11.9–16.2) | (NOS, 6) 3 survived |
Kulick-Soper et al. 2020 [40], United States | Retrospective case report, single centre | 52 | 0 (0) | Not reported | Not reported | 1 Newly diagnosed | No | 1114 | 17.4 | 7.25 | Not reported | 33 | (NOS, 6) Not reported |
Li et al. 2020 [41], China | Retrospective case reports, single centre | 44 (26–44) | 2 (66.7) | Not reported | 3 Asian | 3 Pre-existing T2DM | No | 382 (298–382) | Not reported | 7.22 (6.86–7.22) | Not reported | Not reported | (NOS, 6) 1 survived 2 died |
Marchon et al. 2020 [42], United Kingdom | Retrospective case reports, single centre | 28 | 0 (0) | Not reported | White (Caucasian) | 1 Pre-existing T1DM | No | 401.4 | 12.9 | 7.0 | 3.2 | Not reported | (NOS, 6) 1 survived |
Mondal et al. 2021 [43], India | Prospective case series, single centre | 54.8 ± (11.7) | Males were > females | 24.8 ± (1.92) | 26 Indian | 26 Pre-existing T2DM | No | Not reported | 10.1 ± (1.9) | Not reported | Not reported | Not reported | (NOS, 6) 23 survived 3 died |
Naguib et al. 2021 [44], United States | Retrospective case report, single centre | 8 | 0 (0) |  > 35 | 1 Hispanic | 1 Newly diagnosed | No | 429 | 12 | 7.3 | 14 | 21 | (NOS, 6) 1 survived |
Nielsen-Saines et al. 2021 [45], United States | Retrospective case report, single centre | 7 | 1 (100) | 16.8 | 1 Hispanic | 1 Newly diagnosed | No | 470 | 14.8 | 7.01 | 3.5 | 32 | (NOS, 6) 1 survived |
Omotosho et al. 2021 [46], United States | Retrospective case report, single centre | 45 | 0 (0) | 25.39 | 1 Hispanic | 1 Pre-existing T2DM | No | 344 | 13.7 | 7.22 | 13 | 18 | (NOS, 6) 1 survived |
Oriot et al. 2020 [47], Belgium | Retrospective case report, single centre | 52 | 1 (100) | 29 | 1 White (Caucasian) | 1 Pre-existing T1DM | 1 Yes | 270 | 7.4 | 7.25 | 19 | 17 | (NOS, 6) 1 hospitalized |
Ozer et al. 2020 [48], Turkey | Retrospective case report, single centre | 42 | 0 (0) | Not reported | 1 White (Caucasian) | 1 Pre-existing T2DM | Yes | 196 | Not reported | 7.08 | 8.9 | 20 | (NOS, 5) 1 survived |
Palermo et al. 2020 [49], United States | Retrospective case reports, single centre | 49 (45–49) | 1 [50] | 30.5 (28–30.5) | Not reported | 1 Pre-existing T2DM 1 Newly diagnosed | 1 Yes | 395 (192–395) | 10 (7.5–10) | 7.21 (7.18–7.21) | 17.5 (15–17.5) | Not reported | (NOS, 6) 2 survived |
Panjawatanan et al. 2020 [50], United States | Retrospective case report, single centre | 59 | 1 [100] | 32 | Not reported | 1 Pre-existing T2DM | No | 387 | 11.3 | 7.25 | 19 | 13 | (NOS, 6) 1 survived |
Parwanto et al. 2020 [51], Indonesia | Retrospective case report, single centre | 51 | 1 (100) | Not reported | 1 Asian | 1 Pre-existing T2DM | No | 369 | Not reported | 7.22 | 9.3 | Not reported | (NOS, 5) 1 died |
Pasquel et al. 2021 [52], United States | Retrospective cohort, multicentre | 56 ± (17) | 120 (57.1) | 31 ± (9) | Not reported | Not reported | Not reported | 523 ± (228) | 11.3 ± (2.7) | Not reported | 12.2 ± (4.5) | 27 ± (8) | (NOS, 8) 146 survived 64 died |
Pikovsky et al. 2021 [53], United Kingdom | Retrospective case reports, single centre | 34 (34–34) | 0 (0) | 26.5 (25–26.5) | 1 Asian 1 White (Caucasian) | 1 Pre-existing T2DM 1 Newly diagnosed | No | 77.4 (75.6–77.4) | 11.5 | 7.0 (6.9–7.0) | 6.6 (6.2–6.6) | 21 | (NOS, 6) 2 survived |
Plasencia-Dueñas et al. 2021 [54], Peru | Retrospective case reports, single centre | 64 (42.5–71.2) | 3 (75) | Not reported | 4 Hispanic | 4 Newly diagnosed | No | 740 (489–1108) | Not reported | 7.17 (6.86–7.3) | 11.6 (4–17.6) | Not reported | (NOS, 5) Not reported |
Potier et al. 2021 [55], France | Retrospective case report, single centre | 31 | 1 (100) | Not reported | 1 White (Caucasian) | 1 Newly diagnosed | No | 427 | Not reported | 7.25 | 8 | Not reported | (NOS, 6) 1 survived |
Rabizadeh et al. 2020 [56], Iran | Retrospective case report, single centre | 16 | 1 [100] | 17.7 | 1 Persian | 1 Newly diagnosed | No | 512 | 12.9 | 6.95 | 8 | Not reported | (NOS, 5) 1 survived |
Ramos-Yataco et al. 2021 [57], Peru | Retrospective case reports, single centre | 49 (33–49) | 3 (100) | Not reported | 3 Hispanic | 3 Newly diagnosed | No | 679 (625–679) | 4.5 | 7.1 (6.6–7.1) | 8 (4–8) | 10 | (NOS, 5) 3 survived |
Ramos-Yataco et al. 2021 [58], Peru | Retrospective case series, single centre | 66 (42.5–72.5) | 3 (60) | Not reported | 5 Hispanic | 5 Pre-existing T2DM | No | 538 (465.5–617.5) | 5.9 (5.6–6.7) | 7.2 (6.8–7.2) | 7.7 (4.2–10.7) | 15 (14.5–17) | (NOS, 5) 5 survived |
Rao et al. 2021 (59), United States | Retrospective case series, single centre | 39 (20–54) | 3 (42.8) | 28.6 (26.8–34) | 4 White (Caucasian) 3 Hispanic | 6 Pre-existing T2DM 1 Newly diagnosed | No | 311 (282–596) | 12.8 (10.1–13.9) | 7.25 (7.18–7.37) | 13 (9–19) | 21 (19–33) | (NOS, 6) 6 survived 1 died |
Reddy et al. 2020 (60), India | Retrospective case reports, single centre | 45 (30–45) | 2 (100) | Not reported | 2 Indian | 1 Pre-existing T2DM 1 Newly diagnosed | No | 568 (555–568) | 11.1 (9.6–11.1) | 7.18 (7.07–7.18) | 9.5 (6.1–9.5) | 14 (11.9–14) | (NOS, 6) 2 survived |
Shankar et al. 2021 [61], India | Retrospective case reports, single centre | 13 (11–15) | 3 (60) | Not reported | 5 Indian | 2 Pre-existing T1DM 3 Newly diagnosed | No | 425 (343–513) | 13.5 (11.9–15.5) | Not reported | 10 (3.7–13.7) | Not reported | (NOS, 5) 5 survived |
Singh et al. 2021 [63], United States | Retrospective case series, single centre | 42.5 (32.2–60.2) | 7 (87.5) | 27.3 (24.5–39.9) | 1 Black 6 Hispanic 1 Bengali | 1 Pre-existing T1DM 5 Pre-existing T2DM 2 Newly diagnosed | 1 Yes | 454 (375–543) | 11.4 (10.7–14.4) | 7.15 (7.1–7.3) | 12.5 (7.7–15.5) | 26.5 (22.5–28) | (NOS, 6) 5 survived 3 died |
Singh et al. 2021 [62], United States | Retrospective case series, single centre | 47 (35–79) | 7 (63.6) | 25.7 (23.4–29.3) | 6 Hispanic 2 Black 2 White (Caucasian) 1 Arab | 8 Pre-existing T2DM 2 Newly diagnosed 1 Pre-existing T1DM | 1 Yes | 974 (610–1284) | 13.8 (11.8–15.5) | 7.01 (6.9–7.2) | 5 (4–10) | 34 (30–37) | (NOS, 7) 4 survived 7 died |
Singh et al. 2021 [64], United States | Retrospective case report, single centre | 24 | 1 (100) | 32.1 | Not reported | 1 Pre-existing T1DM | No | 507 | 15.8 | 7.16 | 2 | 30.6 | (NOS, 6) 1 died |
Smati et al. 2020 [65], France | Retrospective case report, single centre | 36 | 0 (0) | 35.2 | 1 Black | 1 Gestational diabetes | No | 111 | 6.1 | 7.22 | 5.8 | Not reported | (NOS, 6) 1 survived |
Soliman et al. 2020 [66], Qatar | Retrospective case report, single centre | 0.7 | Not reported | - | 1 Arab | 1 Newly diagnosed | No | 571 | 8.5 | 7.08 | 7 | 18 | (NOS, 6) 1 survived |
Stack et al. 2020 [67], United States | Retrospective case report, single centre | 40 | 1 (100) | Not reported | Not reported | 1 Pre-existing T1DM | No | 328 | 11.5 | Not reported | 18 | 20 | (NOS, 6) 1 survived |
Stevens et al. 2021 [68], United States | Retrospective cohort, multicentre | 63.6 ± (14.2) | 108 (68.8) |  < 18.5 (4.5%); 18.5 < 25.0 (29.3%); 25.0 < 30.0 (30.6%); > 30.0 (29.3%) | 84 Hispanic 35 Black | 156 Pre-existing T2DM 1 Pre-existing T1DM | Not reported |  > 250 (n = 124) | 10.7 ± (2.8) | Not reported | Not reported | Not reported | (NOS, 6) 99 survived 58 died |
Suwanwongse et al. 2021 [69], United States | Retrospective case reports, single centre | 51 (18–51) | 2 (66.7) | 33 (32–33) | Not reported | 3 Newly diagnosed | No | 496 (353–496) | 11.4 (10.4–11.4) | 7.1 (7.12–7.3) | 17 (15–17) | 25 (19–25) | (NOS, 6) 3 survived |
Thorne et al. 2021 [70], United Kingdom | Retrospective case series, single centre | 31 (25.5–39.5) | 0 (0) | 32.5 (29.7–39) | Not reported | 4 Newly diagnosed | No | Not reported | Not reported | 7.4 (7.22–7.45) | 14.5 (8.1–16.2) | Not reported | (NOS, 6) 4 survived |
Vasconez et al. 2020 [72], United States | Retrospective case report, single centre | 16 | 0 (0) | Not reported | Not reported | 1 Pre-existing T1DM | No | 687 | 13.5 | 6.77 | 3 | 21 | (NOS, 6) 1 survived |
Wallett et al. 2021 [73], United Kingdom | Retrospective case series, single centre | Not reported | Not reported | Not reported | White (Caucasian) | 5 Pre-existing T1DM 15 Pre-existing T2DM | Not reported | 465.3 | Not reported | 7.15 | 11.4 | Not reported | (NOS, 5) Not reported |
Xu and Zia 2020 [74], United States | Retrospective case report, single centre | 55 | 1 (100) | Not reported | Not reported | 1 Pre-existing T2DM | 1 Yes | 525 | Not reported | 7.11 | 8 | 31 | (NOS, 6) 1 survived |
Zavaleta et al. 2020 [75], Peru | Retrospective case reports, single centre | 64 (42.5–71.2) | 3 (75) | Not reported | 4 Hispanic | 1 Newly diagnosed 3 Unknown diabetes type | No | 740 (641–1108) | 14.3 (12–14.3) | 7.17 (6.86–7.3) | 11.6 (4–17.6) | Not reported | (NOS, 6) 2 survived 2 died |