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Aim: People with type 1 or type 2 diabetes have a higher hospital admission rate following Covid-19 infection. This study aims to determine the degree to which the results of a previous study in Greater Manchester (GM) could be replicated in national-level data for England. Method(s): We focussed on the univariable regression analysis, which shows the association between admission and Covid-19 infection in people with diabetes. Modelling was conducted using logistic regression on data from the Covid-IMPACT database. Odds ratios were compared descriptively with the previous study. Result(s): In people with type 2 diabetes, factors associated with an increased risk of hospitalisation similar to the previous study were: older age, male sex, higher social deprivation, higher body mass index (BMI), higher cholesterol, lower eGFR, taking an ACE-inhibitor/ ARB, not taking metformin, and having asthma or hypertension. Patients with COPD, and those taking aspirin or clopidogrel also had increased risk, but the national data showed a greater risk (GM COPD odds ratio 1.89 [1.63-2.19] vs national 2.34 [2.28-2.40] / aspirin 1.49 [1.34-1.66] vs 1.66 [1.63-1.70] / clopidogrel 1.71 [1.47-1.98] vs 1.99 [1.94-2.04]). Similar results were observed in patients with type 1 diabetes. However, due to the increase in sample size, many factors which were previously not statistically significant have become significant, such as in type 2 diabetes BMI, low HDL-cholesterol. Conclusion(s): We have successfully replicated the methods, results and conclusions of our previous study in relation to factors associated with increased risk of hospital admission in diabetes individuals. Regional databases are suitable for large cohort studies, and in this instance produced similar results to a national database, validating our previous findings.
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BACKGROUND: The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals. AIM: To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice. METHODS: A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT. FINDINGS: The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks. CONCLUSION: Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.
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Access to Justice issues have shown us that our traditional adversarial dispute resolution model is slow, costly, divisive and complex - for both self represented litigants and those with lawyers. Addressing these issues through the provision of information to litigants has not been enough. Family Justice reports speak of the need for "culture change" and judicial leadership in affecting change. Judges have created options to the traditional adversarial model with processes such as Settlement Conferences, Binding Settlement Conferences, Informal Trials and Case Management. COVID19 has "forced" courts to embrace Virtual and telephone proceedings. There are now choices in Court based, Judicially-run dispute resolution processes. Nova Scotia's Supreme Court, Family Division has a process "add" - an eCourt Pilot instituting an electronic, chat-based Court process that gives litigants and Judges a new "choice" of process. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response. © 2022 American Chemical Society.
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BACKGROUND: Barriers to rapid return of sequencing results can affect the utility of sequence data for infection prevention and control decisions. AIM: To undertake a mixed-methods analysis to identify challenges that sites faced in achieving a rapid turnaround time (TAT) in the COVID-19 Genomics UK Hospital-Onset COVID-19 Infection (COG-UK HOCI) study. METHODS: For the quantitative analysis, timepoints relating to different stages of the sequencing process were extracted from both the COG-UK HOCI study dataset and surveys of study sites. Qualitative data relating to the barriers and facilitators to achieving rapid TATs were included from thematic analysis. FINDINGS: The overall TAT, from sample collection to receipt of sequence report by infection control teams, varied between sites (median 5.1 days, range 3.0-29.0 days). Most variation was seen between reporting of a positive COVID-19 polymerase chain reaction (PCR) result to sequence report generation (median 4.0 days, range 2.3-27.0 days). On deeper analysis, most of this variability was accounted for by differences in the delay between the COVID-19 PCR result and arrival of the sample at the sequencing laboratory (median 20.8 h, range 16.0-88.7 h). Qualitative analyses suggest that closer proximity of sequencing laboratories to diagnostic laboratories, increased staff flexibility and regular transport times facilitated a shorter TAT. CONCLUSION: Integration of pathogen sequencing into diagnostic laboratories may help to improve sequencing TAT to allow sequence data to be of tangible value to infection control practice. Adding a quality control step upstream to increase capacity further down the workflow may also optimize TAT if lower quality samples are removed at an earlier stage.
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Studies have found that youth are experiencing higher anxiety levels than prior to COVID-19, and youth with type 1 diabetes are at higher risk. Medical specialty camps are a type of camp that provide opportunities for youth with chronic illnesses to share common goals, increase socialization, improve camper well-being, and increase knowledge of diabetes management. The program evaluation sought to determine the impact of a campers' outcomes of independence and perceived competence and familial impact during COVID-19. Over half the participants were at their first diabetes camp and 71% of the campers felt their perceived competence "increased a little bit" because of camp. Over 95% of parents felt that their participation in camp had increased their diabetes knowledge. Qualitative data from parents revealed 2 themes, camp as a meeting place and learning from others. The findings from this study demonstrate that medical specialty camps influence campers' perceptions of independence and competence and that families play an important role in creating a community of practice.
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Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response.
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Objective: To investigate the impact of the coronavirus disease (COVID) pandemic on gambling and problem gambling in Canada. Method(s): A stratified national cohort of regular gamblers (n=2790) completed a comprehensive online questionnaire 6 months before the onset of the pandemic (baseline;August-November 2019), during the nation-wide lockdown (May-June 2020), and 6 months after the lockdown (December 2020). Result(s): Significant decreases in gambling frequency, time spent in gambling sessions, money spent, and the number of game types played occurred during lockdown followed by significant increases in all of these same measures postlockdown. However, the level of postlockdown gambling behavior was still significantly lower than prepandemic baseline levels. A significant shift to online gambling was also observed during the lockdown, which persisted postlockdown. Problem gambling scores also declined during the lockdown, with no significant change in these scores postlockdown. Consistent with previous literature, it was found that a higher level of gambling engagement, online gambling participation, and known biopsychosocial factors (family history of problem gambling, gambling fallacies, substance use, male sex, mood disorder) were predictors of problem gambling at postlockdown. COVID-specific factors predictive of problem gambling postlockdown were the presence of negative COVID-related health impacts and increased levels of social interaction and leisure time. Conclusion(s): The COVID-related lockdowns have resulted in lower levels of gambling and problem gambling symptomatology as well as increased online gambling in Canada that have persisted to some extent 6 months postlockdown. Future studies are necessary to ascertain whether these represent permanent or temporary changes. Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.
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The impact of the COVID-19 global pandemic has been pervasive. From the first report by the World Health Organization (WHO) of a "mysterious pneumonia" sickening dozens in Wuhan, China to 5,680,741 deaths, every social and economic system has been challenged. This descriptive case study utilizes a process of analytic induction to examine Makers Unite, a collaborative personal protection equipment (PPE) production project spearheaded by Open Works, a makerspace in Baltimore, Maryland. The organization produced 28,270 face shields in 56 days, averaging a production rate of 496 per day, serving over 100 clients, and resulting in a contract to produce face shields for meatpacking inspectors. The project included six full-time staff members, five temporary part-time staff members, a network of 388 volunteers and 3D printers, and two partner organizations. The study reveals best practices for establishing Lean small-scale manufacturing, developing institutional trust, community collaboration, and developing a more inclusive, agile supply chain in healthcare equipment production. © 2022, IGI Global. All rights reserved.
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Gambling Fallacies (GF) are a collection of gambling specific cognitive errors that lead to erroneous beliefs about how gambling works. While previous studies have demonstrated that gambling fallacies are one factor that contributes to the development and maintenance of gambling disorder, longitudinal studies have demonstrated that endorsement of these fallacies can fluctuates across time. The factors that influence changes in level of GF are less understood. The current study examined levels of GF in a national cohort of adults, with two aims: 1) examining the associations between GF levels and type of gambler (non-gambler, non-problem gambler, low-risk gambler, moderate-risk gambler and problem gambler), and 2) identifying the impact of COVID specific variables on GF endorsement. This sample (n = 2,790) was recruited from Leger Opinion's registered online panellists. Respondents completed a survey of gambling involvement and individual difference variables at 6-months intervals: baseline (6-months before the pandemic);during the nation-wide lockdown in Canada;and 6-months after the lockdown. The results of this study indicate that, while somewhat more prevalent among problem gamblers, GF are common among gamblers of all types. However, level of GF endorsement did vary significantly at each 6-month interval in this sample and multivariate analysis indicate that GF endorsement was a significant predictor of increased gambling severity category over time. Also, a bidirectional relationship was evidenced as problem gambling and greater gambling involvement were significant predictors of greater endorsement of GF. COVID specific changes in health and level of social interaction also significantly predicted greater GF endorsement.
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The impacts of the COVID-19 pandemic, and responses used to mitigate the spread such as selective closure of non-essential businesses, have been far-reaching. Some of these impacts include changes in health, economic, social and recreation. Included among other non-essential business, in-person gambling venues were closed across Canada. Yet, online gambling opportunities remained available, making this period both a historical first in Canada, and a natural experiment. The current study examined quantifiable ramifications of the sudden forced abstinence from in-person gambling during the nation-wide lockdown in Canada, and what changes occurred six-months later upon reopening. For this cohort study, pre-pandemic base line data was provided six-month before the lockdown by online panel participants (n = 2,790), who were then re-surveyed during the national lockdown and again six-months postlockdown. Nearly one-third of gamblers reported a complete cessation of gambling during the lockdown period. For those who continued gambling, quantitative data indicated signifi-cant decreases on all gambling engagement measures: frequency, time spent in gambling sessions, money spent, and the number of game types played. This was followed by significant increases on each engagement measure six-months post-lockdown. Although these increases did not return to pre-pandemic engagement levels. Problem gambling within the whole sample generally declined during lockdown, however, significant increases in highrisk gambling were evidenced six-months later. In fact, engaging in online gambling and COVID-specific changes in health, employment, and social isolation across the closure and re-opening periods were independent predictors for classification as a problem gambler sixmonths after the lockdown.
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While gambling problems have long been investigated in association with electronic gambling machines, recent attention has focused on engagement with instant lottery games. Instant win game engagement has been identified as one robust predictor of increased concurrent and subsequent problem gambling (see: Grusser et al., 2007;Short et al., 2015;Stark et al., 2021;Williams, Leonard, et al., 2021;Williams, Leonard, et al., 2021). This emergent finding contrasts with historical perceptions that lottery games are low risk. It is important to understand the individual characteristics of those who engage in instant lottery games, the potential harms associated with engagement, and the biopsychosocial profile of those at greatest risk for experiencing harms. This study sought to identify the characteristics that predict engagement versus non-engagement using a longitudinal data set, namely the AGRI National COVID Project online panel participant data (n = 3449), collected in Fall 2019 (baseline data for this study) and in Spring 2020 (during the nation-wide pandemic lockdown). Results indicate that, pre-pandemic factors including gender, employment status, household financial status, greater involvement in gambling, and elevated problem gambling scores, contributed significantly to the delineation of those who did - versus did not - engage in instant win games during the national lockdown. Additional research is required to understand both, the individual characteristics that lead to susceptibility for problems with instant win games, and the role of environmental factors including social and economic strain experienced during the COVID-19 pandemic in the manifestation of problems related with instant win game engagement.
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Background: Janus kinase inhibitors (JAKi) are relatively new to the feld of rheumatology and provide health professionals in rheumatology (HPRs) with more therapeutic options for treating infammatory arthritis (IA), specifcally rheumatoid arthritis (RA) and psoriatic arthritis (PsA) [1]. Aside from a different target, JAKi differ from often currently prescribed biologics by being administered orally. To date, there is a lack of evidence on what HPRs think about their real-world use and how the COVID-19 pandemic affects JAKi prescription. Objectives: To explore UK-based HPRs' perspectives towards JAKi use in IA patients, and in the context also of the COVID-19 pandemic. Methods: A 15-item anonymous online survey, with both closed and open-ended questions, was designed and piloted on 5 HPRs with amendments made based on their feedback. The survey was advertised on Twitter and shared by email in September 2021. Data were exported from the online survey platform and analysed descriptively with the assistance of statistical software. Results: Fifty-one HPRs responded to the survey: 37 Consultants, 7 Registrars, 5 Clinical Nurse Specialists, 1 Clinical Fellow and 1 'other rheumatology role' (not stated). Responses were received from 11/12 UK regions. Most represented was Greater London (18%) and North-West England (16%). 69% of respondents worked in secondary care, with the remaining 31% in tertiary care. The majority (40%) spent 1-25% of their job role doing research, followed by 27% who were not research active. 60% of HPRs indicated that 1-5% of their RA and/or PsA patients take a JAKi (no HPRs had more than 15% of their RA/PsA patients on a JAKi). 96% of HPRs indicated that they prescribe JAKi in their clinical practice, with 91% of those who prescribe following their local guidelines. 72% of respondents who prescribe JAKi, prescribed them 'frequently' as a monotherapy. Figure 1 shows responses chosen for when JAKi therapy is usually started and for feeling less confdent with JAKi prescription. Of those HPRs who prescribe, 17% have continued JAKi in their patients. When discontinuation occurred, the most common reasons chosen (multiple responses allowed) were 'due to inefficacy' (60%), 'due to other adverse events' i.e., non-major adverse cardiovascular events (32%) and 'due to herpes zoster infection' (28%). 55% of HPRs would consider switching patients to another JAKi after initial failure. Across prescrib-ers, 49% indicated no impact of the COVID-19 pandemic on their prescribing of JAKi. Common reasons chosen for a change in prescribing patterns for JAKi as a result of the pandemic (multiple responses allowed) included: prescribing them more as 'an alternative to infusions, in order to reduce hospital visits' (23%) and as 'an alternative to injections, in order to reduce at-home training visits' (21%). This was followed by 'other reason' (15%) with the free text from all 7 respondents highlighting the benefts of the shorter half-life of JAKi e.g., 'Prescribed more as quick on and quick off so can be discontinued quickly in event of severe infection' (Registrar, Greater London). Safety concerns around the use of JAKi were raised in 13/14 free text comments left at the end of the survey e.g., 'I am concerned about recent reports of increased VTE [venous thromboembolism] and malignancies' (Consultant, Yorkshire and the Humber) and 'Concerns about cardiovascular safety' (Clinical Fellow, Scotland). Conclusion: A large proportion of HPRs indicate confdence in prescribing JAKi to their patients with IA, adhering to local guidelines. JAKi are largely prescribed as monotherapy, with the most frequent reason for discontinuation being ineffi-cacy. The COVID-19 pandemic seems to have positively impacted JAKi prescription, however, safety concerns over JAKi use remain for some HPRs.
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Background With the COVID-19 pandemic there was an acute drop in procedural volume for trainees, highlighting the need and potential of simulation-based training (SBT). Prior to the pandemic, the uptake of simulation was poorly categorized and inconsistent across programs despite the variety of endoscopic simulators available. We aimed to evaluate the current state of endoscopy training internationally in the wake of the pandemic as perceived by trainees. Methods This cross-sectional study utilized a survey composed of 21 questions eliciting demographic data, COVID-19-related training experiences, and experience with SBT. This survey was distributed internationally (USA, Canada, EU, Philippines, Singapore) to gastroenterology trainees between August 2021 to October 2021. Results The questionnaire was completed by 182 fellows, with 55 (30.2%) from the USA and 127 (69.8%) from other countries. Of the respondents, 79.1% were fellows during the first year of the pandemic. A majority (69.2%) found endoscopy training in general to be negatively impacted. Of those who reported a negative impact from the pandemic, 75.0% attributed it to a decline in endoscopic volume, 40.0% to institutional/regional guidelines, 25.0% to a shortage of personal protective equipment. Overall, 47.2% of respondents believed COVID-19 will negatively affect their endoscopic proficiency upon fellowship completion. A total of 71 respondents (39.0%) had experienced SBT before or during fellowship, with 27 from the USA (49.1% of respondents from USA) and 44 from other countries (34.6% of respondents from other countries). In the USA, 63.0% had used virtual reality (VR), 37.0% mechanical models, and 37.0% animal models compared to 47.7% VR, 68.2% mechanical models, and 27.3% animal models in other countries. Respondents agreed that SBT was most helpful with developing technical skills such as ergonomic handling, torque steering, and fine tip control. A majority (52.1%) found SBT appropriate to their level of training. Respondents believed increased access to SBT (43.7%) and mentored training (54.9%) would improve the experience. Conclusion While current data supports the use of SBT early in training, the cumulative uptake of SBT across programs before and during the COVID-19 pandemic remained low. In the USA and abroad, fellows perceive a negative impact of COVID-19 on their training and proficiency upon graduation. Compared to other countries, the USA had higher utilization of VR and lower utilization of mechanical models. Decrease in endoscopic volume was reported as the main factor negatively impacting endoscopic training. This survey highlights the potential benefit of SBT with low case volumes and further prospective evaluation of SBT in achieving endoscopic competence. (Table Presented)
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Background The COVID-19 pandemic led to significant alterations in the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening, though the impact on different types of healthcare systems remains unclear. We aimed to quantify and compare the effect of the first wave of the pandemic on CRC screening uptake at a safety-net hospital and a private health system based in New York City (NYC). Methods In this retrospective study, we identified individuals aged 50 to 75 years presenting for outpatient care at a safety-net public hospital (Bellevue Hospital) and private health system (NYU Langone Health) in March through September of 2019 and 2020 (first wave of the pandemic in NYC). We excluded those who were up-to-date with CRC screening before each study period or had a prior diagnosis of CRC, hereditary cancer syndrome, inflammatory bowel disease, or colectomy. The primary outcome was the proportion of screening-eligible patients seen in the outpatient setting who underwent CRC screening. Results The safety-net hospital had a total of 9,569 outpatient visits in 2019 and 7,280 in 2020. Overall, 552 (5.8%) and 289 (4.0%) screening tests were completed in 2019 and 2020, respectively (p < 0.01). Of these, there were 382 (69.2%) fecal immunochemical tests (FIT) in 2019 and 256 (88.6%) in 2020 (p < 0.01). For individuals who had positive FIT results, 17.2% in 2019 and 25.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.62). A total of 5 and 3 cases of CRC were diagnosed in 2019 and 2020, respectively. In the private health system, there were 99,889 visits in 2019 and 33,849 in 2020. Overall, 658 (0.66%) and 250 (0.74%) completed screening tests in 2019 and 2020, respectively (p = 0.13). Of the screening tests, 518 (78.7%) were FIT in 2019 and 206 (82.4%) were in 2020 (p = 0.22). Of the positive FIT results, 29.4% in 2019 and 27.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.80). A total of 97 and 43 CRC cases were diagnosed in 2019 and 2020, respectively. Conclusion In our study of a safety-net hospital and a private health system in NYC, outpatient volume and absolute numbers of screening tests and CRC diagnoses decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening rate and increase in proportional FIT use in the public hospital but not the private health system. Although colonoscopy follow-up rate after positive FIT results were low for both institutions, which may reflect incomplete capture of colonoscopy examinations, there were no differences before and during the pandemic. (Table Presented) (Table Presented)
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Introduction: People with diabetes are particularly at high risk of becoming seriously unwell after contracting covid-19 infection. We do not fully understand underlying factors contributing to such risk/their respective contributions to outcomes. Methods: This population-based study included people living in the Greater Manchester conurbation with a recorded diagnosis of type 1 diabetes and type 2 diabeetes +subsequent covid-19 infection. Each individual with type 1 diabetes (n = 862)/ type 2 diabetes (n = 13,225) was matched with 3 covid-19 infected non-diabetes controls. Results: For type 1 diabetes individuals, the hospital admission rate in the first 28 days after covid-19 positive test was 10%vs4.7% in age/gender-matched controls (relative risk [RR] 2.1). For type 2 diabetes individuals, the hospital admission rate in the first 28 days after a covid-19 positive test was 16.3%vs11.6% in age/gender-matched controls(RR 1.4). Average Townsend score was higher in type 2 diabetes (1.8) vs matched controls(0.4), with a higher proportion of type 2 diabetes people in the top 2 quintiles of greatest disadvantage(p < 0.001). Within the group of covid-19 infected type 1 diabetes affected individuals, factors influencing the likelihood of admission included;age/body mass index (BMI)/ hypertension/ HbA1c/low HDL-cholesterol/ lower estimated glomerular filtration rate(eGFR)/COPD/being of African/ mixed ethnicity. In covid-19 infected type 2 diabetes individuals, factors potentially related to a higher admission rate included;age/Townsend Index/co-morbidity with COPD/asthma and severe mental illness(SMI)+lower eGFR. Metformin prescription lowered the admission likelihood. Conclusion: In a UK population, we have confirmed significantly higher likelihood of admission in people with diabetes following covid-19 infection. Several factors mediate the increased likelihood of hospital admission including metformin. For type 2 diabetes, the majority of factors related to increased admission rate are common to the general population but more prevalent in type 2 diabetes.
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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.