Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jul 15, 2020
Open Peer Review Period: Jul 15, 2020 - Sep 9, 2020
Date Accepted: Oct 25, 2020
(closed for review but you can still tweet)
Clinical characteristics and outcomes in diabetes patients admitted with COVID-19 in Dubai: a cross-sectional single centre study.
ABSTRACT
Background:
The burden of the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), which is known as COVID-19 has being increasing worldwide. According to World Health Organisation (WHO), COVID-19 was declared as an epidemic on 11th March 2020.1 To date 49,069 cases have been reported in the United Arab Emirates (UAE) with 316 deaths.2 Recent studies have suggested that diabetes is a major risk factor contributing to severity of illness and mortality from COVID-19.3 For example, a meta-analysis of seven trials in China showed that 9.7% of 1576 patients with COVID-19 had diabetes.4 Diabetes is also a major risk factor for the development of a more severe pneumonia and clinical course due to COVID-19 infection, and occurs in around 20-30% of such patients. 5 In addition, poor glycaemic control whether related to diabetes or stress hyperglycemia is also known to be associated with poor patient outcomes including hospitalisation and death. 6 In a large population-based study in England, 23,804 COVID-19 related deaths were reported. Of these, one third occurred in people with diabetes: 7,466 (31∙4%) with Type 2 and 365 (1∙5%) with Type 1 diabetes.7
Objective:
The aim of this Dubai-based, single-centre cross-sectional study was to assess the clinical characteristics and outcomes of patients with diabetes admitted with moderate to severe COVID-19 illness.
Methods:
A cross-sectional observational study was conducted in patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates (UAE) from 30th March to 7th June 2020. They had laboratory and/or radiologically confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), known as COVID-19. Variation in characteristics, length of stay in hospital, diabetes status, comorbidities and outcomes were examined.
Results:
A total of 103 patients with confirmed COVID-19 presentations had diabetes. During the same timeframe, 410 patients overall were admitted with COVID-19 infection. This gives a total proportion of persons admitted with COVID-19 infection and coexistent diabetes/prediabetes of 25%. 67% (n=69) of the COVID-19 diabetes cohort were male. Patients admitted with COVID-19 and diabetes represented 17 different ethnicities. Of these, 59.2% (n=61) were Asians and 35% (n=36) were from Arab countries. Mean age (SD) was 54 (12.5) years. 85.4% (n=88) were known to have diabetes prior to admission, while 14.6% (n=15) were newly diagnosed with either diabetes or prediabetes during admission. Most patients in the study cohort had type 2 diabetes or prediabetes, with only 3% overall having type 1 diabetes (n=3). 46.9% of patients had evidence of good glycaemic control of their diabetes during the preceding 4-12 weeks prior to admission as defined arbitrarily by admission HbA1c <7.5%. 73.8% (n=76) had other comorbidities including hypertension, ischaemic heart disease, and dyslipidaemia. Laboratory data Mean(SD) on admission for those who needed ward-based care versus those needing intensive care unit (ICU) care: Fibrinogen 462.75 (125.16) mg/dl vs 660 (187.58) mg/dl ; D-dimer 0.66 (0.55) mcg/ml vs 2.3 (3.48) mcg/ml; Ferritin 358.08 (442.05) mg/dl vs 1762.38 (2586.38) mg/dl; and CRP 33.9 (38.62) mg/L vs 137 (111.72) mg/L were all statistically significantly higher for the ICU cohort (p<0.05). Average length of stay in hospital was 14.55 days. 28.2% of patients needed ICU admission. 4.9% (n=5) overall died during hospitalisation (all in ICU).
Conclusions:
In this single-centre study in Dubai, 25% of patients admitted with COVID-19 also had diabetes/prediabetes. Most diabetes patients admitted to hospital with COVID-19 disease were males of Asian origin. 14.6% had new diagnosis of diabetes/prediabetes on admission. The majority of patients with diabetes/prediabetes and COVID-19 infection had other important comorbidities (n=76; 73.8%). Only 4 patients had negative COVID-19 RT-PCR but had pathognomonic changes of COVID-19 radiologically. Our comprehensive laboratory analysis revealed distinct abnormal patterns of biomarkers that are associated with poor prognosis: Fibrinogen, D-dimer, Ferritin and CRP levels were all statistically significantly higher (p<0.05) at presentation in patients who subsequently needed ICU care compared with those patients who remained ward-based. 28.2% overall needed ICU admission, out of which 5 patients died. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.
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