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

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

doi:10.3389/fendo.2021.777130

Abstract

ObjectiveTo identify clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care admission amongst diabetes patients admitted with COVID-19.Research Design and MethodsWe conducted a cohort study collecting data from medical notes of hospitalised people with diabetes and COVID-19 in 7 hospitals within the Mersey-Cheshire region from 1 January to 30 June 2020. We also explored the impact on inpatient diabetes team resources. Univariate and multivariate logistic regression analyses were performed and optimised by splitting the dataset into a training, test, and validation sets, developing a robust predictive model for the primary outcome.ResultsWe analyzed data from 1004 diabetes patients (mean age 74.1 (± 12.6) years, predominantly men 60.7%). 45% belonged to the most deprived population quintile in the UK. Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. The primary outcome (7-day mortality) occurred in 24%, increasing to 33% by day 30. Approximately one in ten patients required insulin infusion (9.8%). In univariate analyses, patients with type 2 diabetes had a higher risk of 7-day mortality [p < 0.05, OR 2.52 (1.06, 5.98)]. Patients requiring insulin infusion had a lower risk of death [p = 0.02, OR 0.5 (0.28, 0.9)]. CKD in younger patients (<70 years) had a greater risk of death [OR 2.74 (1.31-5.76)]. BMI, microvascular and macrovascular complications, HbA1c, and random non-fasting blood glucose on admission were not associated with mortality. On multivariate analysis, CRP and age remained associated with the primary outcome [OR 3.44 (2.17, 5.44)] allowing for a validated predictive model for death by day 7.ConclusionsHigher CRP and advanced age were associated with and predictive of death by day 7. However, BMI, presence of diabetes complications, and glycaemic control were not. A high proportion of these patients required insulin infusion warranting increased input from the inpatient diabetes teams.

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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