ABSTRACT
Background: Diabetes mellitus has been considered a significant risk factor for morbidity and mortality for COVID-19.1 HbA1c levels are often used as a marker of poor glycaemic control and are one way of diagnosing pre-diabetes as well as diabetes.2,3 We tried to explore whether HbA1c levels could be an independent risk factor for mortality and morbidity in patients with positive coronavirus (SARS-COv-2) swabs. Methods: This was a retrospective multicentre study of coronavirus swab positive patients who had a recent HbA1c test. Their demographic data, medical history, COVID-19 swab and laboratory results, and final outcomes were analysed. Patients were divided into three groups;HbA1c in normal (group 1), pre-diabetic (group 2) and diabetic (group 3) ranges. Data were analysed using JASP and statistical computation using a χ2 test. Results: A total of 1,226 patients had SARS-CoV-2 RNA identification swabs between 10 February 2020 and 1 May 2020. A cohort of 120 of these patients had positive swab results and recent HbA1c results. Mortality rates for group 1 (normal HbA1c) and 3 (diabetic HbA1c) were relatively higher than group 2 (pre-diabetic HbA1c). Among group 2, female patients had greater mortality, perhaps because of fewer male patients, although overall co-morbidity was less (4/120 (3.33%) in group 2 compared with 18/120 (15%) in group 1 and 14/120 (11.66%) in group 3. Overall, 36/120 (30%) patients died and 84/120 (70%) survived. Survival curves after analysis of data showed that increasing HbA1c levels were associated with poorer outcomes across all groups. Analysis was significant with p=0.003. Conclusions: HbA1c levels in this study were an independent marker of increased risk of mortality in COVID-19 swab positive patients. The findings are statistically significant (p=0.003). Increased co-morbidities at normal HbA1c seem to have a contributing role in enhanced mortality.
ABSTRACT
Introduction: The practice of Telemedicine is still in its infancy in our country. Lack of awareness, as well as acceptance both on the part of patients and professionals, has been cited as the principal reason behind the delay in its full-fledged development. The Apollo Hospital backed “eACCESS” tele ICU service has been functional since 2013 and has remotely managed over 4,000 ICU patients in the last 3 years in several hospitals in our country. Continuous round the clock monitoring of critically ill patients has been possible with the use of remote technology. The global COVID-19 pandemic has united all nations against a common enemy: the novel coronavirus. In times like these where social distancing is the new norm, the timely release of the Telemedicine Practice Guidelines by the Government of India has enabled healthcare professionals to evaluate, diagnose, and triage remotely. We have currently extended our monitoring services for COVID-19 patients at many remote locations in India like Dadri (UP), Bahr (Bihar), Kaniha (Odisha), Vindhyachal (MP), Korba (Chhattisgarh), and Ramagundam (Telangana). Materials and methods: Our workflow has evolved with time and we do a minimum of two interactions per remote site every day. Qualified and trained intensive care physicians are monitoring patients in shifts along with specially trained critical care nurses. Standard guidelines issued by The Ministry of Health and Family Welfare for COVID-19 treatment are being followed. Awake proning of conscious patients is also being done at these locations under supervision. We are also providing education to the medical personnel at these remote sites regarding the monitoring of ICU patients, follow-up of investigations, basic medical emergencies, and how to manage them. Interestingly the minimum distance of our remote connection is 100 km and the maximum distance is 1,550 km. Results: We have monitored over 1700 COVID-19 positive cases since March 2020 at various locations within the Apollo campus in Hyderabad and at remote sites. Majority of the patients admitted for COVID care were males (68.7%). The patient population varied from 8 years to 84 years. We have the capacity to monitor 120 COVID patients at a given point of time. The average length of stay in the hospital is approximately 4.5 days. Triaging and reporting of Electrocardiograms from remote sites is also done from our command center. We have reported 3432 ECGs during this period. We have also provided 409 sub-specialist tele consultations through the eACCESS program since March 2020. Discussions: Tele-ICUs not only provide 24∗7 monitoring of critically ill patients but stand with the bedside team as the first line of care. This modality has helped decrease the frequency and need to physically enter an isolation room. The direct visualization and monitoring of COVID-19 patients have also allowed for the early detection of many emergencies like a drop in oxygen saturation, disconnection from NIV, ventilator circuit issues, etc. Since most of the intensivists are predominantly concentrated in the metro cities, Tele-ICU services have plugged a major gap in the existing healthcare delivery system by providing quality care to smaller rural areas. Patients can have access to remote expertise from the comfort of their homes. Conclusion: The ongoing COVID-19 pandemic has not only highlighted the shortage of ICUs but also the shortage of trained medical personnel and resources (like personal protective equipment, PPE). Tele-ICU solution can help bridge these barriers by conserving PPE, minimizing exposure, and avoiding infection through constant remote monitoring.