{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:27:05Z","timestamp":1779110825419,"version":"3.51.4"},"reference-count":28,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["S Afr Fam Pract"],"abstract":"<jats:p>Background:\u00a0Coronavirus disease 2019 (COVID-19) is associated with an increased prevalence and mortality from diabetic ketoacidosis (DKA) globally. With limited access to specialised care, most patients with DKA in South Africa are managed at district hospital level. This study describes the profile of patients admitted to a district hospital in South Africa with DKA and COVID-19 and examines associated risk factors encountered.Methods:\u00a0This was a case series of all patients presenting to a district hospital with DKA and COVID-19 infection between July 2020 and July 2021. Data extracted included patients\u2019 demographic profiles, biochemical results, comorbidities and clinical outcomes.Results:\u00a0The median age of the 10 patients admitted during the study period was 39 years old (\u00b112), six of whom were male. The hemoglobin A1c (HbA1c) values on admission ranged from 9.7 to 13.8. Five of the patients had pre-existing type 2 diabetes mellitus (DM). Four of the known DM patients were on metformin only, and one was on biphasic insulin. Three patients had other pre-existing comorbidities, two patients with hypertension and one with human immunodeficiency virus (HIV). Three patients demised, two of whom were hypoxic on admission.Conclusion:\u00a0Diabetic ketoacidosis appears more commonly in COVID-19 infected patients with type 2 DM and at a young age. Suboptimal glycaemic control was associated with DKA, and hypoxia was a strong predictor for mortality. Treatment inertia was evident in the known DM group, who were on monotherapy despite persistent hyperglycaemia. Greater vigilance is required to detect ketosis in type 2 DM and intensify therapy to improve glycaemic control.<\/jats:p>","DOI":"10.4102\/safp.v64i1.5590","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T13:36:53Z","timestamp":1663767413000},"source":"Crossref","is-referenced-by-count":3,"title":["COVID-19 and diabetic ketoacidosis: A case series at an urban district hospital in South Africa"],"prefix":"10.4102","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9819-5130","authenticated-orcid":false,"given":"Heather N.","family":"Dicks","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2698-950X","authenticated-orcid":false,"given":"Keshena","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2580","published-online":{"date-parts":[[2022,9,22]]},"reference":[{"key":"ref0001","doi-asserted-by":"publisher","DOI":"10.18632\/aging.103000"},{"key":"ref0002","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2010419"},{"key":"ref0003","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00244.2021"},{"key":"ref0004","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa360"},{"key":"ref0005","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2018688"},{"key":"ref0006","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-020-0165-1"},{"key":"ref0007","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2011.03246.x"},{"key":"ref0008","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2022.102389"},{"issue":"1","key":"ref0009","first-page":"1","volume":"27","author":"Bhikoo","year":"2021","journal-title":"J Endocrinol Metab Diabetes S Afr"},{"key":"ref0010","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14057"},{"key":"ref0011","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2021.101267"},{"key":"ref0012","doi-asserted-by":"publisher","DOI":"10.4102\/phcfm.v10i1.1612"},{"key":"ref0013","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2020.08.015"},{"key":"ref0014","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108166"},{"key":"ref0015","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2020.07.050"},{"key":"ref0016","first-page":"23247096211021231","volume":"9","author":"Singh","year":"2021","journal-title":"J Investig Med High Impact Case Rep"},{"key":"ref0017","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-52-6-1235"},{"key":"ref0018","author":"International Diabetes Federation","journal-title":"IDF diabetes atlas South Africa diabetes report"},{"key":"ref0019","author":"National Institute for Communicable Diseases","year":"2022","journal-title":"Latest confirmed cases of Covid-19 in South Africa [homepage on the Internet]"},{"key":"ref0020","author":"Nicole","year":"2020","journal-title":"How is the COVID-19 virus detected using real time RT-PCR [homepage on the Internet]"},{"issue":"1","key":"ref0021","first-page":"S1","volume":"21","author":"The Society for Endocrinology Metabolism and Diabetes of South Africa Committee, Type 2 Diabetes Guidelines Committee","year":"2017","journal-title":"J Endocr Metab Diabetes S Afr"},{"issue":"1","key":"ref0022","first-page":"S1","volume":"22","author":"Jivan","year":"2017","journal-title":"J Endocrinol Metabol Diabetes S Afr"},{"key":"ref0023","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30271-0"},{"key":"ref0024","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00241-2"},{"key":"ref0025","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00208-4"},{"key":"ref0026","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6775"},{"key":"ref0027","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1966"},{"key":"ref0028","first-page":"75","volume":"48","author":"Wexler","year":"2021","journal-title":"J. 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