Short term follow-up of patients presenting with acute onset diabetes and diabetic ketoacidosis during an episode of COVID-19.
Short term follow-up of patients presenting with acute onset diabetes and diabetic ketoacidosis during an episode of COVID-19.
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DOI：
10.1016/j.dsx.2020.10.015
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Mishra SK
中科院分区：
文献类型：
--
作者：
Kuchay MS;Reddy PK;Gagneja S;Mathew A;Mishra SK
对于没有糖尿病史的个体来说，严重急性呼吸道综合征冠状病毒-2（SARS-CoV-2）感染可能会诱发急性发作的糖尿病和糖尿病酮症酸中毒（DKA）。然而，关于这些人的后续行动的数据很少。三名患有2019年冠状病毒病（COVID-19）引发的急性发作糖尿病和DKA的患者（两名患者的数据已发表）被随访14周，以评估糖尿病的行为。详细记录病史、人体测量、实验室检查、影像学检查、临床病程和结局。3人出现疑似SARS CoV-2感染的症状。几天后，根据逆转录-聚合酶链反应（RT-PCR）检测和胸部成像，他们被检测出患有COVID-19肺炎。与此同时，他们还患上了急性糖尿病和DKA，这是由COVID-19引发的。他们对治疗反应良好，包括静脉输液和胰岛素。大约一周后，他们被转换为多次皮下注射胰岛素。大约4-6周后，他们的胰岛素需求减少，开始口服降糖药。在最后一次随访（14个月）时，他们用口服降糖药控制了血糖。COVID-19可在一些无糖尿病史的个体中诱发急性发作的糖尿病和DKA。这些特征类似于1型糖尿病。然而，4-6周后，他们对外源性胰岛素的需求减少，并对口服降糖药物有反应。需要长期随访，以进一步了解这些人中SARS CoV-2感染引起的糖尿病类型。在某些个体中，COVID-19诱导类似1型糖尿病的糖尿病，其特征为急性发作和DKA。然而，他们对胰岛素的需求在大约4-6周后减少。随后，他们的糖尿病可以通过口服降糖药得到控制。
Acute onset diabetes and diabetic ketoacidosis (DKA) can be precipitated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in individuals with no history of diabetes. However, data regarding the follow-up of these individuals are scarce. Three patients (data of two patients already published) with acute onset diabetes and DKA, precipitated by coronavirus disease 2019 (COVID-19), were followed for 14 weeks to assess the behavior of the diabetes. Detailed history, anthropometry, laboratory investigations, imaging studies, clinical course and outcomes were documented. Three individuals developed symptoms suggestive of SARS CoV-2 infection. After a few days, they were detected to have COVID-19 pneumonia, based on reverse transcription-polymerase chain reaction (RT-PCR) assay and chest imaging. In the meantime, they also developed acute onset diabetes and DKA, which were precipitated by COVID-19. They responded well to treatment, including intravenous fluids and insulin. After around one week, they were transitioned to multiple shots of subcutaneous insulin. After about 4–6 weeks, their insulin requirement diminished and oral antihyperglycemic drugs were initiated. At the last follow-up (14 months), they had controlled glycemia with oral antihyperglycemic medicines. COVID-19 can induce acute onset diabetes and DKA in some individuals with no history of diabetes. These features resemble type 1 diabetes. However, after 4–6 weeks, their requirement for exogenous insulin diminishes and respond to oral antihyperglycemic medications. Long term follow up is required to further understand the type of diabetes induced by SARS CoV-2 infection in these individuals. In some individuals, COVID-19 induces diabetes resembling type 1 diabetes, characterized by acute onset and DKA. However, their requirement for insulin diminishes after around 4–6 weeks. Subsequently their diabetes can be controlled with oral antihyperglycemic medicines.
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