Clinical Characteristics of COVID-19 Patients in a Regional Population with Diabetes Mellitus: The ACCREDIT Study

Daniel Kevin Llanera,Ram Prakash Narayanan,Rahul Yadav,Sam Westall,Paulo Lisboa,Stephanie Wong,Dushyant Sharma,Haika Shoo,Sunil Nair,Rebekah Wilmington,Zubair Qureshi,Surya Rajeev,Niall Furlong,Jael Nizza,Dhanya Kalathil,Scott Williams,Ian Jarman

doi:10.2139/ssrn.3785999

Abstract

Background: It is known that diabetes is associated with greater COVID-19 mortality. However, what remains unclear is whether characteristics specific to this cohort contribute to the prognosis of COVID-19. We identified clinical and biochemical characteristics associated with mortality and the need for intensive care amongst an inpatient population with diabetes and COVID-19.Methods: We conducted a retrospective cohort study across the North West Merseyside region assessing clinical and biochemical characteristics associated with 7-day, 30-day mortality, and ITU admission as primary outcomes. All patients with diabetes infected with COVID-19 admitted to 7 hospitals within the region from 1 January to 30 June 2020 were included and data collected directly from medical notes by clinicians managing the condition. We calculated the inpatient mortality rates for this cohort. Statistical analyses included multivariate logistic regression to examine the effect of the aforementioned characteristics on the primary outcome. We also performed a series of Kaplan-Meier curves to assess the mortality rate trend over time.Findings: This study analysed 1004 hospitalised patients with diabetes with COVID-19. Mean age was 74.1 (± 12.6) years. They were predominantly men (60.7%). 45% belonged to the two most deprived deciles in the UK. Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. Most had a diagnosis of T2DM (94.8%) and the mean HbA1c was 61.2 ± 19.7 mmol/mol (7.7 ± 4%). Microvascular and macrovascular complications of diabetes were evident in 49.6% and 56.2% respectively. The primary outcome of death by day 7 was observed in 24%, which increased to 33% by day 30. In univariate analysis, characteristics associated with the primary outcome were age and CRP (pInterpretation: The results of this regional analysis of persons with diabetes infected with COVID-19 showed that CRP and age were associated and predictive for in-hospital death by day 7.Funding: None.Conflict of Interest: NoneEthical Approval: The study was approved by the Regional Research ethics committee.

Highlights

As of 8 June 2021, an estimated 172 million people have been afflicted by coronavirus disease 2019 (COVID-19) with a death toll of 3.7 million worldwide [1]
This study aimed to identify clinical and biochemical characteristics associated with mortality and the need for intensive care in people with diabetes and COVID-19 admitted to secondary and tertiary United Kingdom (UK) National Health (NHS) hospitals within the Cheshire and Merseyside regions of North West England
We explored diabetes-related events including insulin infusion requirement, the incidence of diabetic ketoacidosis (DKA) or ketosis, incidence of severe hypoglycaemia and the need to escalate anti-hyperglycaemic therapy

Summary

Introduction

As of 8 June 2021, an estimated 172 million people have been afflicted by coronavirus disease 2019 (COVID-19) with a death toll of 3.7 million worldwide [1]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with ACE-2 serving as its cellular receptor, presents with a wide spectrum of clinical manifestations from asymptomatic cases to severe lifethreatening pneumonia and acute respiratory distress syndrome (ARDS). At present over 150,000 people in the United Kingdom (UK) have died with COVID-19, one of the highest case fatalities in Europe [3]. Risk factors for poor outcomes appear to be male sex, advanced age, diabetes, hypertension, obesity, and cardiovascular disease among others [4,5,6]. There is evidence suggesting an increased risk of mortality among Black, Asian, and Minority Ethnic (BAME) populations [7]

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