{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:27:07Z","timestamp":1793237227807,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The impact of COVID\u201019 infection on diabetic ketoacidosis (DKA) outcomes remains incompletely characterized at a national level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed adult DKA hospitalizations in the United States from the 2020\u20132021 National Inpatient Sample. The primary outcome was in\u2010hospital mortality; secondary outcomes included acute kidney injury (AKI), mechanical ventilation, sepsis, vasopressor use, length of stay (LOS), and hospitalization cost. Multivariable regression and propensity score matching adjusted for patient\u2010 and hospital\u2010level variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 658,675 DKA hospitalizations, 69,005 (10.5%) involved COVID\u201019. Patients with COVID\u201019 were older and had a greater comorbidity burden. Crude in\u2010hospital mortality was higher with COVID\u201019 (21.3% vs 3.4%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). After adjustment, COVID\u201019 was associated with over sixfold higher mortality (aOR 6.22; 95% CI: 5.85\u20136.62), increased risks of AKI (aOR 1.15), ventilation (aOR 3.91), sepsis (aOR 1.77), vasopressor use (aOR 2.33), longer LOS (+3.99\u2009days), and higher costs (+$15,248; all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Propensity\u2010matched analysis confirmed these findings. In subgroup analysis, type 1 diabetes was linked to higher mortality (aOR 2.12) vs type 2 diabetes. Predictors of mortality included age, comorbidity burden, hospital size, and Hispanic ethnicity; female sex was protective only in COVID\u201019 DKA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this national analysis, COVID\u201019 significantly worsened mortality, multiorgan failure, and healthcare utilization in DKA admissions. DKA with COVID\u201019 represents a high\u2010acuity entity warranting early escalation and resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdi.70217","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:56:55Z","timestamp":1768899415000},"page":"535-541","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["<scp>COVID<\/scp>\n                    \u201019 and diabetic ketoacidosis: National outcomes, predictors, and resource utilization in the United States"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4636-0493","authenticated-orcid":false,"given":"Jia Ee","family":"Chia","sequence":"first","affiliation":[{"name":"Department of Medicine Texas Tech University Health Science Center  El Paso Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8557-9880","authenticated-orcid":false,"given":"Song Peng","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Medicine Rutgers Health Community Medical Center  Toms River New Jersey USA"},{"name":"Division of Cardiology, Department of Medicine University of Arizona  Tucson Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Chozet","sequence":"additional","affiliation":[{"name":"Department of Medicine Texas Tech University Health Science Center  El Paso Texas USA"},{"name":"Division of Endocrinology Texas Tech University Health Science Center  El Paso Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3761-576X","authenticated-orcid":false,"given":"Eunseuk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine Rutgers Health Community Medical Center  Toms River New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Iglesias","sequence":"additional","affiliation":[{"name":"Department of Medicine Rutgers Health Community Medical Center  Toms River New Jersey USA"},{"name":"Department of Medicine Hackensack Meridian School of Medicine  Nutley New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6712a3"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00244.2021"},{"key":"e_1_2_8_4_1","article-title":"Acute kidney injury associated with severe SARS\u2010CoV\u20102 infection: Risk factors for morbidity and mortality and a potential benefit of combined therapy with tocilizumab and corticosteroids","volume":"11","author":"Iglesias J","year":"2023","journal-title":"Biomedicine"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2021.05.013"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2021.101267"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-20-0567"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2022.102389"},{"key":"e_1_2_8_9_1","article-title":"Evaluation of characteristics and outcomes for patients with diabetic ketoacidosis (DKA) with and without COVID\u201019 in Elmhurst Queens during similar three\u2010month periods in 2019 and 2020","volume":"13","author":"Patel U","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_8_10_1","volume-title":"HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP)","author":"Agency for Healthcare Research and Quality","year":"2020"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.1091"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154301"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00241-2"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00208-4"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2020.08.015"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-020-00435-4"},{"key":"e_1_2_8_17_1","doi-asserted-by":"crossref","unstructured":"CoateK ChaJ ShresthaS et\u00a0al.SARS\u2010CoV\u20102 cell entry factors ACE2 and TMPRSS2 are expressed in the pancreas but are not enriched in islet endocrine cells.bioRxiv. 2020.","DOI":"10.1101\/2020.08.31.275719"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-97711-8"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.739757"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13293-020-00304-9"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1008570"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.15605\/jafes.033.02.03"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60111833"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/00033197241308045"}],"container-title":["Journal of Diabetes Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdi.70217","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jdi.70217","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdi.70217","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:28:35Z","timestamp":1773012515000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jdi.70217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,20]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/jdi.70217"],"URL":"https:\/\/doi.org\/10.1111\/jdi.70217","archive":["Portico"],"relation":{},"ISSN":["2040-1116","2040-1124"],"issn-type":[{"value":"2040-1116","type":"print"},{"value":"2040-1124","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,20]]},"assertion":[{"value":"2025-06-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}