ABSTRACT
Introduction Management of type 1 diabetes mellitus (T1 DM) patients in early adulthood is associated with unique challenges. COVID-19 pandemic had significantly impacted the quality of patient follow-up and access to care. This study assessed the characteristics of T1 DM patients under diabetes onestop clinic (DOSC) follow-up in Hospital Sultan Haji Ahmad Shah (HoSHAS), Temerloh, Pahang and the impact of the pandemic on diabetes control. METHODOLOGY In this cross-sectional study, all T1 DM patients under active follow-up were recruited. Data regarding demographics, diabetes control and COVID-19 infection status were reviewed. Further analyses were performed by dividing them into 2 groups according to COVID-19 infection status: COVID-19 positive (group 1) and COVID-19 negative (group 2). Results Thirty T1 DM patients [60% female, 63.3% Malay ethnicity, mean age 24.4 (SD7.4) years, median weight 58.35(IQR 10.3) kg, median disease duration 6.0 (IQR 8.0) years, mean duration under DOSC follow-up 4.1(SD 1.6) years] were analysed. Incident retinopathy was seen in 10.0% of patients. Within the past 12 months, 26.7% had recent hospitalisation, majority due to diabetes ketoacidosis. Within the past 3 months, 13.3% had experienced hypoglycaemia. Mean HbA1c in T1 DM increased steadily from 2019 to 2020 and 2021 (8.87% vs 8.93% vs 9.35%). Thirteen T1 DM patients (46.4%) had COVID-19 infection between 2020 and 2022. Patients with COVID-19 infection had lower HbA1c than those not infected but it was not statistically significant (8.74% vs 9.07%, p=0.82). They also tended to have more microvascular complications. Conclusion COVID-19 pandemic had negatively impacted diabetes control in our cohort. There was also a high hospitalisation rate during this period. The HbA1c level was not associated with increased risk of COVID-19 infection in our cohort.
ABSTRACT
Introduction Individuals with diabetes have similar risk of contracting COVID-19 infection compared to those without diabetes. However, COVID-19 patients with diabetes are at a higher risk for severe outcomes and death. The occurrence of hyperglycaemic emergency and diabetic ketoacidosis (DKA) may worsen the outcomes of COVID-19 infection. This study will determine the characteristics of COVID-19 patients admitted with hyperglycaemic emergency and mortality outcomes in Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang. Methodology All electronic records of COVID-19 patients admitted from March 2021 until March 2022 were reviewed for occurrence of hyperglycaemic emergency. Data regarding demographics, clinical presentation, laboratory investigations and clinical outcomes were collected. Further analysis with patients subcategorised into 2 timelines: March-December 2021 (group 1) and January-March 2022 (group 2) reflecting two surges of COVID-19 admission to the hospital was done. Results Twenty-four COVID-19 patients with hyperglycaemic emergency [mean age 56.7 (SD 15.6) years, 54.2% female, 79.2% Malay ethnicity, 95.8% type 2 diabetes mellitus, 54.2% unvaccinated, 70.8% category 5 infection] were analysed. Majority of patients had DKA at 79.2% [mean pH 7.16(SD 0.12), mean HCO3 10.80 (SD 3.07), mean glucose at diagnosis 25.3 (SD 11.0) mmol/L]. The mean length of hospitalisation was 11.42 (SD 7.4) days and mortality rate was 63.2%. Nine DKA cases were detected in group 1 compared to 10 cases during the shorter timeline in group 2. All patients had resolved DKA but the majority succumbed later due to complications of COVID-19 infection. Mortality rates in both groups were 66.7%(n=6) and 60%(n=6), respectively. Conclusion Despite high occurrence of uncontrolled diabetes during COVID-19 infection in this cohort, only a small proportion had hyperglycaemic emergency. In both timeline of hospitalisation surge, COVID-19 patients with concomitant hyperglycaemic emergency had poorer prognosis.