ABSTRACT
Aims: We have shown previously in 93 individuals with type 1 diabetes using the FreeStyle Libre flash glucose monitor that the week after their first Covid-19 vaccination, the percent 'time in target range 3.9-10mmol/ l' (%TTR) average went from 55.2%-> 52.4% (effect size -5.1%) with 58% of people recording a fall. 47 (50%) people with HbA1c < 56mmol/mol %TTR went from 69.3-> 63.5 (-8.3%) and 24 (25%) people using insulin+oral treatment 56.7%-> 50.7% (-10.1%). We have now repeated the exercise after the most recent Covid-19 vaccination. Method(s): FreeStyle Libre data and medical records of the same patients from the previous study were examined for the week before and week after their most recent Covid-19 vaccination. () in the results section show change in %TTR as % of the prior value to show effect size. TTR% results from 2 weeks before and after were also considered. Result(s): Median time between vaccines was 38 weeks IQR (37-40). After the latest vaccination average %TTR average went from 51.1%-> 49.8% (-2.5%) with a reduction found in 54% of patients. Impact on the 39 patients with HbA1c < 56mmol/mol -% TTR from 66.2%-> 61.8% (-6.5%) and the 20 (25%) patients using insulin+oral %TTR from 48.2%-> 47.1% (-2.2%). 65% of the patients whose %TTR fell previously, fell again after this vaccination. Fortnight average %TTR 53.5%-> 52.1% (-2.7%) whereas in the previous study across fortnight %TTR 55.4%-> 54.0% (-2.4%). Conclusion(s): The perturbation effect on blood glucose with 1st Covid-19 vaccination was seen again in the latest vaccination but reduced in magnitude, confirming that a significant group of type 1 diabetes individuals' glycaemic control is still being impacted by the Covid-19 vaccination.
ABSTRACT
Background: Management of acute respiratory distress in patients with COVID-19 has changed over the course of the pandemic. The impact of length of time on High Flow Nasal Cannula (HFNC) prior to mechanical ventilation is unknown. Methods: This is a multi-center retrospective chart review of COVID-positive hospitalized patients, who received mechanical ventilation from March 2020- October 2021. The primary outcome variable was survival to discharge, variables collated included patient demographics, vital signs, comorbidities, including the Charlson comorbidity index (CCI), as well as critical care therapeutic and diagnostic interventions. Results: All COVID-19 positive patients, with respiratory failure who underwent mechanical ventilation across study sites were included (N=709), of which 318 (45%) were accrued in March-May 2020. Patients had an average age of 62 (SD=15) years, majority male (67%), and an average CCI of 3.65 (SD=3.11). The unadjusted mortality for mechanically ventilated patients in our cohort was 56% (n=397). 169 (54%) of the remaining 312 were discharged home. Mortality varied over the study period, with the highest noted Nov 1st 2020 - Jan.31st 2021 (N=141, 69.8%) compared to other time periods (47-53%, p<0.0001). Notably at this time patients had the longest duration of pre-intubation high-flow oxygen support (mean 6.3 days vs. 4.2 days overall), the highest rate of Non-Invasiave Positive Pressure Ventilation (NIPPV) utilization (49% vs. 33% overall) and the lowest PaO2 to FiO2 ratio (mean 125 vs. 139 overall) (p<0.01). Duration of HFNC was independently associated with a higher risk of post-intubation mortality: OR (95% CI) = 3.1 (1.8-5.4) for 3-7 days, 7.2 (3.8-13.7) for ≥8 days (reference: 1-2 days) (p<0.0001) (accounting for age, gender, BMI and CCI). Furthermore, the magnitude of this association was found to vary between age groups: for 3-7 days duration (ref: 1-2 days), OR = 4.8 (1.9 - 12.1) in ≥65 years old vs. 2.1 (1.0 - 4.6) in <65 years old. Notably, at 8 days or more of HFNC, the association with age was reversed for ≥8 days duration (ref: 1-2 days): OR = 5.3 (2.0 - 13.9) in ≥65 years old vs. 8.6 (3.7 - 20.0) for <65 years old. Conclusion: The prolonged use of high flow oxygenation prior to mechanical intubation increased the risk of mortality, particularly in young patients use of HFNC for 8 days or more was associated with significantly higher mortality.
ABSTRACT
Introduction: In this study we set out to determine the relative likelihood of death following covid-19 infection in people with type 2 diabetes when compared to those without type 2 diabetes. Methods: Analysis of digital health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of type 2 diabetes and subsequent covid-19 confirmed infection. Each individual with type 2 diabetes (n = 13,807) was matched with three covid-19 infected non-diabetes controls (n = 39583). Results: For type 2 diabetes individuals, their mortality rate after a covid-19 positive test was 7.7% vs 6.0% in matched controls;the relative risk (RR) of death was 1.28. From univariate analysis performed within type 2 diabetes individuals, likelihood of death following covid-19 recorded infection was lower in people taking metformin, sodium glucose cotransporter-inhibitor 2(SGLT-2i) or glucagon-like peptide-1( GLP-1) agonist. A lower estimated glomerular filtration rate (eGFR) was associated with a higher mortality rate, as was hypertension history. Likelihood of death following covid-19 infection was also higher in those people with diagnosis of COPD/severe enduring mental illness, and in people taking aspirin/ clopidogrel/insulin. Smoking in people with type 2 diabetes significantly increased mortality rate. In combined analysis of type 2 diabetes patients/controls, multiple regression modelling indicated that factors independently relating to higher likelihood of death (accounting for 26% of variance) were: type 2 diabetes/age/ malegender/social deprivation (higher Townsend index). Conclusion: Following confirmed infection with covid- 19 a number of factors are associated with mortality in type 2 diabetes individuals. Prescription of metformin, SGLT-2is or GLP-1 agonists + non-smoking status associated with reduced risk of death for people with type 2 diabetes. Age/male sex/social disadvantage associated with an increased risk of death.