Clinical characteristics and outcomes of diabetic ketoacidosis in patients with type 2 diabetes during acute systemic stress

Abstract Background Many reports indicate that diabetes is one of the main risk factors for COVID-19 complications. Nevertheless, few studies have examined how DKA develops in T2DM patients who have SARS-CoV-2 infection. Objectives This study aimed to assess β-cell function, identify risk factors for DKA, and evaluate clinical outcomes in hospitalized patients with T2DM and COVID-19. Methods A retrospective, single-center, case–control study was conducted at Ain Shams University Isolation Hospital from August 2021 to August 2022. The study included 70 adults with T2DM and confirmed COVID-19, categorized into two groups: 35 patients with DKA (cases) and 35 patients without DKA (controls). Clinical, laboratory, and outcome data were extracted from medical records. Results Fasting C-peptide levels did not differ significantly between the DKA and non-DKA groups (median difference: −0.06 ng/mL, 95% CI − 0.28 to 0.16; p = 0.363), suggesting that absolute insulin deficiency was not the primary driver of DKA in this cohort. The DKA group was significantly older (mean difference: 9.8 years, 95% CI 4.2 to 16.0; p = 0.003) and had a longer median diabetes duration (median difference: 3.7 years, 95% CI 1.3 to 6.1; p = 0.009). These patients also presented increased levels of inflammatory and stress markers, including D-dimer (mean difference: 0.21 ng/mL, 95% CI 0.05 to 0.37; p = 0.020) and HOMA-IR (median difference: 1.93, 95% CI 0.45 to 3.60; p = 0.012). Mortality was significantly greater in the DKA group (22.9% vs. 0%, risk difference 22.9%, 95% CI 8.4% to 37.4%; p = 0.003). Conclusion In patients with T2DM and COVID-19, DKA was not characterized by absolute insulinopenia but was associated with older age, longer diabetes duration, severe insulin resistance, and systemic inflammation. These factors contribute to significantly increased morbidity and mortality. Our findings highlight the multifactorial nature of DKA in this setting and underscore the importance of aggressive monitoring and management in high-risk patients. Clinical trial number Not applicable.