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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
  1. DKA Diabetic ketoacidosis, SGLT2 Sodium-glucose Cotransporter-2, SARS-CoV-2 severe acute respiratory syndrome coronavirus 2; NOS Newcastle Ottawa Scale, T1DM type 1 diabetes mellitus, T2DM type 2 diabetes mellitus
  2. aPatients with black ethnicity include African-American, Black African, African and Afro-Caribbean patients
  3. bData are presented as median (25th-75th percentiles), or mean ± (SD)