30 patients are included in this retrospective analysis, with their demographics demonstrated in Table 1. 21 (70%) of these patients received treatment for both COVID-19 and a diabetic emergency during their admission. 2 patients with COVID-19 needed an ITU admission, one of whom died. This mortality was also COVID-19 RT-PCR swab positive.
14 out of 30 included patients were RT-PCR positive patients. 79% (n = 2) had Type 2 Diabetes. 86% (n = 12) of RT-PCR patients were males and 14% (n = 2) females with average age of 51.47 ± 17.30 years. 5 patients presented with DKA, 1 with HHS, 3 with a mixed DKA/HHS picture and 5 with hyperglycaemic ketosis. In terms of ethnicity, there were patients that were African (n = 5), White British (n = 1), Caucasian and Asian (including eastern and southern asia) (n = 6). 47% of RT-PCR patients were discharged home within 7 days.
7 patients were RT-PCR negative but treated for COVID-19 due to high degree of clinical suspicion. The average age was 47.33 ± 20.46 years, with 5 males and 2 females. 43% of these patients had Type 1 diabetes. 1 patient had DKA, 2 had HHS, 2 had a mixed picture with one patient having hyperglycaemic ketosis. 67% of patients had been successfully discharged home within 7 days.
For the patients that were not treated for COVID-19 (n = 9), all patients had DKA despite the fact that 33% had Type 2 diabetes. There were 4 males and 5 females. 67% (n = 6) of these patients were insulin treated, and 100% were discharged home within 7 days of admission.
Table 1
Baseline Demographics of all patients that were management for both a diabetic emergency and COVID-19, including destination at 7 days
| COVID-19 Swab Positive (n = 14) | COVID-19 Swab Negative, High Clinical Suspicion of COVID-19 (n = 7) | Non COVID-19 patients (n = 9) |
Age (years), mean ± SD | 51.21 ± 17.92 | 47.33 ± 20.46 | 42.00 ± 18.83 |
Gender, n (%) | | | |
Male | 12 (85.7) | 5 (71.4) | 4 (44.4) |
Female | 2 (14.3) | 2 (28.6) | 5 (55.6) |
Ethnicity, n (%) | | | |
African | 4 (28.6) | 4 (57.1) | 2 (22.2) |
Asian | 4 (28.6) | 1 (14.2) | 0 (0.0) |
White British | 1 (7.1) | 1 (14.2) | 4 (44.4) |
Caucasian | 3 (21.4) | 1 (14.2) | 3 (33.3) |
Mixed | 1 (7.1) | 0 (0.0) | 0 (0.0) |
Unknown | 1 (7.1) | 0 (0.0) | 0 (0.0) |
Diabetic Diagnosis, n (%) | | | |
Type 1 | 1 (7.1) | 3 (42.9) | 5 (55.6) |
Type 2 | 11 (78.6) | 4 (57.1) | 4 (44.4) |
New Diagnosis, n (%) | 1 (7.1) | 0 (0.0) | |
Diabetic Emergency, n (%) | | | |
DKA | 5 (35.7) | 1 (14.2) | 9 (100.0) |
HHS | 1 (7.1) | 2 (28.6) | 0 (0.0) |
Mixed DKA/HHS | 3 (21.4) | 1 (14.2) | 0 (0.0) |
Hyperglycaemic Ketosis | 5 (35.7) | 1 (14.2) | 0 (0.0) |
Redeveloped Emergency | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Pre-Admission Medication, n (%) | | | |
Metformin | 8 (57.1) | 5 (71.4) | 3 (33.3) |
DDP4 inhibitors | 1 (7.1) | 1 (14.2) | 1 (11.1) |
Insulin | 7 (50.0) | 3 (42.9) | 6 (66.7) |
Other hypoglycaemics | 4 (28.6) | 2 (28.6) | 1 (11.1) |
No prior medication/Diet controlled | 4 (28.6) | 1 (14.2) | 0 (0.0) |
ITU Admissions, n (%) | 2 (14.3) | 1 (14.2) | 2 (22.2) |
Destination at 7 days, n (%) | | | |
Discharged | 5 (35.7) | 6 (85.7) | 9 (100.0) |
Ward | 7 (50.0) | 0 (0.0) | 0 (0.0) |
ITU | 1 (7.1) | 0 (0.0) | 0 (0.0) |
Died | 1 (7.1) | 1 (14.2) | 0 (0.0) |
DKA – diabetic ketoacidosis; HHS – Hyperosmolar Hyperglycaemic State; Other oral hypoglycaemics include sulfonylureas, glucagon like peptide 1 agonists
Table 2 demonstrates the admission gas results, blood tests and glycosylated haemoglobin (HbA1c) as well as selected COVID-19 markers. Broadly routine admission blood tests were similar when averaged and compared between the three groups. There was a non-significant rise in white cell count going from the RT-PCR patients to non-COVID-19 patients. No significant lymphopenia was observed between any of the three groups.
Admission pH was not significantly different between RT-PCR positive and negative patients (p = 0.533), however there was a significant difference between RT-PCR positive COVID-19 patients and our non-COVID-19 patients (p = 0.028). There was a significant difference between RT-PCR positive COVID-19 patients and our non-COVID-19 patients with regards to HCO3 (p = 0.04). There was a significant difference in the C-Reactive Protein (p = 0.026) and Glucose (p = 0.045) between RT-PCR positive and negative patients.
Kaplan-Meier survival curves were drawn for the groups, comparing all-cause mortality. This is shown in Fig. 1. It demonstrates that the cumulative survival time drops if being treated for COVID-19, and more so if treated for COVID yet RT-PCR negative.
Table 2
Admission Blood test results including some COVID-19 markers
Blood test result mean ± SD | COVID-19 Swab Positive (n = 14) | COVID-19 Swab Negative, High Clinical Suspicion of COVID-19 (n = 7) | COVID-19 Swab Negative, Low Clinical Suspicion of COVID-19 (n = 9) | pa | pb | pc |
Admission Blood glucose (mmol/l), | 23.86 ± 8.38 | 33.29 ± 11.49 | 26.34 ± 12.47 | 0.045 | 0.573 | 0.272 |
Serum Ketones (mmol/l) | 4.44 ± 2.53 | 5.6 ± 2.51 | 5.67 ± 0.99 | 0.314 | 0.154 | 0.943 |
Time for ketone resolution (hours) | 43.10 ± 44.01 | 25.70 ± 15.81 | 28.44 ± 20.60 | 0.413 | 0.378 | 0.794 |
Admission HbA1c (mmol/mol) | 115.30 ± 42.85 | 91.83 ± 12.27 | 109.75 ± 46.95 | 0.217 | 0.834 | 0.387 |
Pre admission HbA1c | 99.38 ± 31.18 | 70.60 ± 39.76 | 73.33 ± 15.70 | 0.131 | 0.210 | 0.893 |
(mmol/mol) | | | | | | |
Haemoglobin (g/l) | 139.92 ± 24.63 | 143.86 ± 18.45 | 134.67 ± 39.42 | 0.717 | 0.703 | 0.580 |
WCC (x109/l) | 10.06 ± 3.46 | 10.37 ± 4.16 | 12.54 ± 4.31 | 0.857 | 0.149 | 0.328 |
Platelets (x109/l) | 281.08 ± 94.39 | 283.71 ± 76.84 | 296.44 ± 103.53 | 0.950 | 0.722 | 0.790 |
Lymphocytes (x109/l) | 1.25 ± 0.55 | 1.32 ± 0.77 | 1.26 ± 0.95 | 0.814 | 0.953 | 0.909 |
Sodium (mmol/l) | 141.08 ± 13.08 | 155.43 ± 38.33 | 134.11 ± 9.07 | 0.229 | 0.183 | 0.126 |
Potassium (mmol/l) | 5.28 ± 0.82 | 5.51 ± 1.13 | 5.22 ± 1.35 | 0.601 | 0.913 | 0.653 |
Urea (mmol/l) | 13.41 ± 12.73 | 15.47 ± 6.74 | 15.16 ± 13.16 | 0.696 | 0.758 | 0.955 |
Creatinine (micromoles/litre) | 183.77 ± 186.70 | 179.71 ± 48.96 | 122.67 ± 52.29 | 0.956 | 0.354 | 0.043 |
eGFR | 53.67 ± 30.09 | 41.86 ± 16.38 | 73.22 ± 27.25 | 0.224 | 0.580 | 0.089 |
CRP (mg/l) | 88.32 ± 68.07 | 26.83 ± 24.35 | 57.40 ± 123.91 | 0.026 | 0.459 | 0.485 |
Ferritin (ng/ml) | 1321 ± 1015.79 | 921.67 ± 432.28 | - | | | |
LDH (U/L) | 391.60 ± 227.32 | 414.33 ± 164.69 | - | | | |
Bilirubin (micromole/litre) | 5.85 ± 3.34 | 6.43 ± 3.60 | 7.00 ± 4.64 | 0.721 | 0.504 | 0.792 |
ALT (iu/l) | 34.00 ± 49.96 | 28.85 ± 11.87 | 25.50 ± 16.03 | 0.452 | 0.244 | 0.657 |
ALP (iu/L) | 92.23 ± 32.24 | 86.14 ± 46.52 | 125.67 ± 60.13 | 0.734 | 0.106 | 0.174 |
CK (U/L) | 2033.50 ± 2035.76 | | | | | |
INR | 1.87 ± 2.28 | 1.10 ± 0.09 | 1.07 ± 0.07 | 0.434 | 0.411 | 0.415 |
PT | 17.87 ± 19.24 | 11.48 ± 0.92 | 11.27 ± 0.68 | 0.437 | 0.422 | 0.653 |
APTT | 37.00 ± 24.89 | 27.833 ± 4.26 | 31.00 ± 3.29 | 0.395 | 0.572 | 0.180 |
Blood Gas | | | | | | |
pH | 7.24 ± 0.17 | 7.18 ± 0.22 | 7.06 ± 0.18 | 0.533 | 0.028 | 0.263 |
HCO3- | 15.79 ± 7.40 | 13.33 ± 8.73 | 9.23 ± 6.36 | 0.506 | 0.040 | 0.295 |
Lactate | 3.70 ± 6.18 | 3.08 ± 0.40 | 3.22 ± 2.38 | 0.813 | 0.828 | 0.891 |
pa – difference between COVID-19 RT-PCR positive and COVID-19 RT-PCR negative patients; pb – difference between COVID-19 RT-PCR positive and non COVID-19 patients; pc – difference between COVID-19 RT-PCR negative patients and non COVID-19 patients.
WCC – white cell count; eGFR – estimated glomerular filtration rate; CRP – C Reactive Protein; ALT – Alanine Transaminase; ALP – Alkaline Phosphatase; CK – Creatine Kinase; INR – International Normalised Ratio; PT – Prothrombin Time; APTT – activated partial thromboplastin time