307- Clinical characteristics of COVID-19 patients in a regional population with diabetes: the ACCREDIT study

Published Date: 01st September 2021

Publication Authors: Narayanan RP

Background and aims
Diabetes is associated with greater COVID-19 morbidity and mortality. However, it is unclear if characteristics specific to this cohort affect the prognosis of COVID-19. ACCREDIT study explored clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care amongst diabetes patients hospitalised with COVID-19.

Materials and methods:
This retrospective cohort study involved hospitalised diabetes patients with COVID-19 across Mersey-Cheshire region. We collected data directly from medical notes from 7 hospitals from 1 January to 30 June 2020 with approval from regional research ethics committee. We calculated mortality rates and made Kaplan-Meier curves to assess the mortality rate trend over time. We also explored the impact of COVID-19 on inpatient diabetes team resources. To examine the effect of characteristics on the primary outcome, univariate and multivariate logistic regression analyses were done and optimised by splitting the dataset into training, test, & validation sets to develop a robust predictive model.

Results
We analysed data from 1004 diabetes patients (mean age 74.1 (± 12.6) years, predominantly men 60.7%). 45% of the patients belonged to the most deprived deciles in the UK - greater than regional average (34.75%). Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. Microvascular and macrovascular complications of diabetes were seen in 49.6% and 56.2% respectively. The primary outcome of death by day 7 was observed in 24%, increasing to 33% by day 30. Only 7.5% of patients needed intensive care. Roughly 1 in 10 patients required insulin infusion (9.8%) and diabetes therapy escalations (11.9%). In univariate analyses, patients with type 2 diabetes had a higher risk of 7-day mortality (p < 0.05, OR 2.52 [1.06, 5.98]). Patients requiring insulin infusion had a lower risk of death (p = 0.02, OR 0.5 [0.28, 0.9]). CKD in younger patients (<70 years) had a greater risk of death (OR 2.74 [1.31-5.76]). No significant association was seen in BMI, diabetes complications, latest HbA1c, and use of RAS blockers. On multivariate analysis, CRP and age remained associated with the primary outcome (OR 3.44 [2.17, 5.44]) and were used in developing a validated predictive model for death by day 7.

Conclusion
CRP and age were predictive of in-hospital death by day 7. Using these two variables in the validated model enables early prognostication of this cohort during their hospitalisation. Higher 7-day mortality rate was observed compared to other studies, possibly due to greater socioeconomic deprivation and older age. Young patients with CKD had a greater risk of early death. A high proportion of these patients required diabetes treatment escalations warranting increased input from the inpatient diabetes teams.

 

Llanera, D; Narayanan, R et al. (2021). 307- Clinical characteristics of COVID-19 patients in a regional population with diabetes: the ACCREDIT study. Diabetologia. 64(Suppl 1), p.S160. [Online]. Available at: https://link.springer.com/article/10.1007/s00125-021-05519-y [Accessed 20 March 2023]

 

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