COVID-19 and hyperglycaemic emergencies: perspectives from a developing country

Keywords: COVID-19, dexamethasone, diabetes, diabetic ketoacidosis, hypokalaemia

Abstract

Background: Pre-existing diabetes mellitus (DM), hyperglycaemia and obesity emerged as prognostic factors in severe Coronavirus disease 2019 (COVID-19). To date, no published South African studies report on the incidence, presentation and outcomes of DM and diabetic ketoacidosis (DKA) during the COVID-19 pandemic.

Objective: To reflect on the diagnosis, management, obstacles to care and outcome of four patients who were admitted to Tygerberg Hospital, Cape Town, South Africa. The outcome of these cases that presented consecutively with DKA and COVID-19 between May and July 2020 are discussed, the presentation, management and long-term considerations with specific reference to DKA and COVID-19 are reviewed.

Results: Three of the four patients had newly diagnosed DM. These patients presented with non-specific symptoms and signs leading to a diagnosis of both DKA and COVID-19. The single surviving patient in this series was known to have pre-existing DM but discontinued his insulin upon becoming unwell. One patient required insulin therapy at the time of initial presentation a week or two prior to the current admission but received metformin instead. She was diagnosed with COVID-19 after having poor glycaemic control for over one week, after which insulin was initiated. Ultimately she died as a result of severe hypokalaemia. One patient primarily had respiratory complaints, severe COVID-19 pneumonia and received concomitan dexamethasone. Glycaemic control in this patient was complicated by both hypo- and hyperglycaemia.

Conclusion: These cases highlight the management challenges faced by many developing countries, and identify the missed opportunities in persons presenting with COVID-19 and hyperglycaemic emergencies.

Author Biographies

Raisa Bhikoo, Stellenbosch University

Department of Medicine, Stellenbosch University and Tygerberg Hospital, South Africa

Marli Conradie-Smit, Stellenbosch University

Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital and Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa

Gerhard van Wyk, Karl Bremer Hospital

Department of Medicine, Karl Bremer Hospital, South Africa

Sa’ad Lahria, Stellenbosch University

Department of Medicine, Stellenbosch University and Tygerberg Hospital and Department of Family and Emergency Medicine, Stellenbosch University and Khayelitsha Hospital, South Africa

Elizabeth Du Plessis, Stellenbosch University

Department of Medicine, Stellenbosch University and Tygerberg Hospital, South Africa

Jaco Cilliers, Stellenbosch University

Department of Medicine, Stellenbosch University and Tygerberg Hospital, South Africa

Susan Hugo, Stellenbosch University

Department of Medicine, Stellenbosch University and Tygerberg Hospital, South Africa

Ankia Coetzee, Stellenbosch University

Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital and Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa

Published
2022-03-28
Section
Case Study