Original Research

COVID-19 and diabetic ketoacidosis: A case series at an urban district hospital in South Africa

Heather N. Dicks, Keshena Naidoo
South African Family Practice | Vol 64, No 1 : Part 4| a5590 | DOI: https://doi.org/10.4102/safp.v64i1.5590 | © 2022 Heather N. Dicks, Keshena Naidoo | This work is licensed under CC Attribution 4.0
Submitted: 25 May 2022 | Published: 22 September 2022

About the author(s)

Heather N. Dicks, Department of Family Medicine, Northdale Hospital, Pietermaritzburg, South Africa; and, Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Keshena Naidoo, Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa


Background: Coronavirus 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: This 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’ demographic profiles, biochemical results, comorbidities and clinical outcomes.

Results: The median age of the 10 patients admitted during the study period was 39 years old (±12), 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: Diabetic 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.


COVID-19; diabetic ketoacidosis; diabetes; district hospital; HbA1c


Total abstract views: 2146
Total article views: 2216

Crossref Citations

No related citations found.