The prevalence of diabetes and the association with all-cause mortality among patients presenting with COVID-19 at a tertiary hospital in the North-West Province, South Africa

ABSTRACT

The relationship between diabetes and Covid is bi-directional, and we analysed the factors impacting mortality in these patients whereby a cohort of adult patients diagnosed with COVID-19 at a public hospital in the North-West Province, South Africa were analysed.

Methods: Retrospective review of patients diagnosed with COVID-19 at Klerksdorp/Tshepong Hospital Complex between June 2020 and May 2021 was done and the patient journey summarised. Using univariate and multivariate logistic regression, we identify factors associated with multiple outcomes along the patient journey including inpatient versus outpatient management, admission to ICU, and all-cause mortality.

Results: Among the 846 patients with Covid the prevalence of diabetes was 20.2% with 11 patients being newly diagnosed with diabetes (11/171; 6.4%). The prevalence of diabetes was higher among those managed as inpatients (142/486; 29.2%) compared to outpatients (29/360; 8.1%). More than a third of patients with moderate or severe COVID-19 had diabetes (100/261) – mostly with poorly controlled HbA1c (>8%) (48/71; 68%). We found that patients with diabetes were more likely to present with severe COVID-19 (RR 4.09 95% CI 2.48-6.76), had more co-morbidities and were more likely to be managed as inpatients (RR 1.63 95% CI 1.47-1.80), admitted to ICU (aRR 1.99 95% CI 1.21-3.27) and die (RR 3.16 95% CI 1.27-7.88) compared to those without diabetes.

Conclusion: COVID-19 patients with diabetes had more severe outcomes than those without diabetes and they merit closer monitoring with more intensive medical intervention to manage their diabetes alongside the COVID-19 infection.