Uncovering the alarming rise of diabetic ketoacidosis during COVID-19 pandemic: a pioneer African study and review of literature.

Autor:	Gorchane A; Department of Endocrinology, University Hospital of Farhat Hached, Sousse, Tunisia.; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia., Ach T; Department of Endocrinology, University Hospital of Farhat Hached, Sousse, Tunisia.; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia.; Laboratory of Exercice Physiology and Pathophysiology, Tunis, Tunisia., Sahli J; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia.; Department of Community Medicine, University Hospital of Farhat Hached, Sousse, Tunisia., Abdelkrim AB; Department of Endocrinology, University Hospital of Farhat Hached, Sousse, Tunisia.; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia., Mallouli M; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia.; Department of Community Medicine, University Hospital of Farhat Hached, Sousse, Tunisia., Bellazreg F; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia.; Department of Infectious Diseases, University Hospital of Farhat Hached, Sousse, Tunisia., Hachfi W; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia.; Department of Infectious Diseases, University Hospital of Farhat Hached, Sousse, Tunisia., Chaieb MC; Department of Endocrinology, University Hospital of Farhat Hached, Sousse, Tunisia.; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia., Ach K; Department of Endocrinology, University Hospital of Farhat Hached, Sousse, Tunisia.; University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia.
Jazyk:	angličtina
Zdroj:	Frontiers in endocrinology [Front Endocrinol (Lausanne)] 2023 Jul 26; Vol. 14, pp. 1234256. Date of Electronic Publication: 2023 Jul 26 (Print Publication: 2023).
DOI:	10.3389/fendo.2023.1234256
Abstrakt:	Introduction: Reports around the world indicate that COVID-19 pandemic may be contributing to an increase in the incidence of new onset diabetic ketoacidosis (DKA). This has yet to be studied in Africa. We aimed to compare the incidence trend of new onset DKA before and during the COVID-19 pandemic, with a focus on the type of diabetes mellitus (DM).Materials and methodsThis was a cross sectional analytical study, over a 4-year period, between March 2018 until February 2022 conducted in the referral center: diabetology department of university hospital Farhat Hached Sousse, Tunisia. The study population included patients hospitalized for new onset DKA divided in two groups: G1: before COVID-19 pandemic and G2: during COVID-19 pandemic. Patients younger than 14, new onset DM not presenting with DKA, other types of diabetes (monogenic, secondary or pancreatic diabetes) were not included. A statistical analysis of the monthly incidence trend was conducted using the Jointpoint software providing the average monthly percentage of change (AMPC). Results: a total of 340 patients were included:137 registered before the pandemic and 203 during the pandemic, representing a 48.17% increase. The mean monthly incidence of new onset DKA during COVID-19 pandemic was statistically higher than that before COVID-19 pandemic (8.42 ± 4.87 vs 5.75 ± 4.29 DKA per month) (p=0.049). The temporal trend of DKA during the 4-year study showed a significant upward trend with a change in AMPC of +0.2% (p=0.037). The incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) increased by 50% and 44% respectively during COVID-19 pandemic. Anti-glutamic acid decarboxylase (anti-GAD) antibodies' titers significantly increased in G2 compared with G1 (median of 330[Q1-Q3]=[58.5-1795]vs 92.5[Q1-Q3]=[22.5-1074] respectively)(p=0.021). Discussion: The incidence trend of DKA showed an increase during the COVID-19 pandemic along with an increase of T1D and T2D implying that the pandemic may have been the underlying factor of this upward trend. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Gorchane, Ach, Sahli, Abdelkrim, Mallouli, Bellazreg, Hachfi, Chaieb and Ach.)
Databáze:	MEDLINE
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