Misra S, Barron E, Vamos E, et al. - Evidence generated in this study suggests that the numbers and characteristics of people presenting with diabetic ketoacidosis (DKA) during the COVID-19 pandemic period differed from those presenting during the preceding 3 years.

• Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, researchers retrieved data of 8,553 admissions coded with DKA during the first wave, 8,729 during the post-first wave, and 10,235 during the second wave.

• Relative to preceding years, 6% higher DKA admissions were recorded in the first wave of the pandemic, 6% higher in the post-first wave, and 7% higher in the second wave.

• In the first wave, those with pre existing type 1 diabetes showed a reduction in DKA admissions by 19%, those with pre existing type 2 diabetes showed an increase in DKA admissions by 41%, and those with newly diagnosed diabetes showed an increase in DKA admissions by 57%.

• Compared with pre pandemic, older individuals and men had similarly common occurrence of type 2 diabetes DKA admissions but these were higher in those of non-White ethnicities during the first wave.

• In the post-first wave, there was no return of DKA admissions to the baseline level of previous years; patients with type 1 diabetes showed lower DKA admissions by 14%, patients with type 2 diabetes showed 30% higher admissions, and patients with newly diagnosed diabetes showed 56% higher admissions.

• During the second wave, DKA admissions were 25% lower, 50% higher, and 61% higher among patients with type 1 diabetes, patients with type 2 diabetes and patients with newly diagnosed diabetes, respectively.

• The increased impact of DKA might be lowered by promoting awareness of risk factors for DKA in type 2 diabetes and vigilance for newly diagnosed diabetes presenting with DKA during the COVID-19 pandemic.