Diabetic ketoacidosis in COVID-19: what have we learned so far?

Background and aims In December 2019, a pandemic emerged due to a new coronavirus which imposed various uncertainties and discoveries. It has been reported that diabetes is a risk factor for worst outcomes of COVID-19, and also that SARS-CoV-2 infection was correlated with the occurrence of diabetic ketoacidosis (DKA) in patients. The aim of this work is to discuss this correlation emphasizing the main case reports from 2020 while exploring the management of DKA during the course of COVID-19. Method Web of Science, PubMed and Scopus databases were searched using two sets of Medical Subject Heading (MeSH) search terms or Title/Abstract words: Coronavirus Infections (Coronavirus Infections, Middle East Respiratory Syndrome, COVID-19) and Diabetic Ketoacidosis (Diabetic Ketoacidosis, Diabetic Acidosis, Diabetic Ketosis). Results There is a clear correlation between COVID-19 and DKA. The SARS-Cov-2 infection may precipitate both a hyperglycemic state and ketoacidosis occurrence in diabetic and non-diabetic patients, which may lead to fatal outcomes. Conclusion DKA in patients with COVID-19 may increase risk and worse outcomes. Hence, the SARS-Cov-2 infection presents a new perspective towards the management of glycemia and acidosis in diabetic and non-diabetic patients, highlighting the need for rapid interventions to minimize the complications from COVID-19 while reducing its spreading.