COVID-19, ketoacidosis and new-onset diabetes: Are there possible cause and effect relationships among them? Since the beginning of the SARS-CoV-2 pandemic that emerged at the turn of 2019 and 2020 in China, the large number of scientific reports published in the latest issues of I Diabetes, Obesity and Metabolism i and elsewhere almost all showed that patients with diabetes mellitus faced a more severe form of COVID-19 and a high mortality rate.1-4 However, intriguingly, COVID-19 patients with newly diagnosed diabetes had the highest risk of all-cause mortality compared with COVID-19 patients with known diabetes or those with hyperglycaemia without diabetes.3,4 As described in one of the first Italian reports on the disease, according to daily-recorded data from the I Istituto Superiore di Sanità i , this was the case in Italy, the first European country to be severely affected by the epidemic.5 Moreover, more severe multi-organ failure was present in adults with diabetes, providing further explanation for the higher mortality rate observed.1 COVID-19-specific metabolic complications, however, are not yet well characterized. A confounder may also be the high blood concentrations attained by inflammatory markers in patients with COVID-19, which is also typical of DKA, independent of accompanying illness.15,16 It is still unclear whether the inflammatory cascades occurring in DKA and severe COVID-19 cases act synergistically to worsen clinical outcomes. [Extracted from the article]