Comparing the mortality of diabetic and non-diabetic patients with COVID-19 in a uk district general hospital

ABSTRACT

Introduction: Initial reports during the first wave of the pandemic in the United Kingdom have shown that diabetic patients with COVID-19 often had a more severe infection with co-morbidities such as Hypertension (HTN) leading to a poorer prognosis. Males could also be at higher risk of death from COVID-19 as was demonstrated in one study. [1] SARS-CoV-2 has been theorised to trigger the increased secretion of glucocorticoids and catecholamine's due to stress conditions- increasing the frequency of acute hyperglycaemic events such as diabetic ketoacidosis in COVID-19 patients with diabetes. It has been suggested that SARS-CoV-2 enters into islets in the pancreas via angiotensin converting enzyme 2 as its receptor leading to acute beta-cell dysfunction. [2] There is also some evidence to suggest that increased Body Mass Index (BMI) in diabetic patients with COVID-19 is linked with severity of the infection. Objectives: We aim to investigate the impact of diabetes on mortality in patients with COVID-19, and to identify potential prognostic factors therein including body mass index (BMI), co-morbidities and gender. Methods: We undertook a retrospective study of all patients aged ≥ 18 years during the first wave of the pandemic. All patients who had a confirmed diagnosis of COVID-19, via radiological and polymerase chain reaction testing, were included in the study. Data was collected using electronic patient records. Statistical analysis was performed using the Chi Squared Test for impendence. Results: 445 COVID-19 positive patients were included in the study, out of whom 127 (29%) were diabetic. Mortality in diabetic patients (61%) was found to be significantly higher than non-diabetics (48%) (p=0.01). There were no significant differences in mortality between diabetic and non-diabetic patient when grouped for BMI ≥25 (p=0.4), Male (p=0.06), Female (0.19) and hypertension (p=0.12). Conclusion: Our study demonstrated how diabetic patients with COVID-19 had a significantly higher mortality rate compared to non-diabetics. This prompts the need to educate diabetic patients about hyperglycaemia arising from infection, the importance of sick day rules and compliance with social isolation measures. Further research is required to investigate the causes behind the raised mortality rate in diabetics.