COVID-19 outcomes in people with diabetes in Wales: a secondary analysis of the ABCD audit

Authors

  • David M Williams Department of Diabetes & Endocrinology, Singleton Hospital, Swansea Bay University Health Board, Swansea UK https://orcid.org/0000-0001-9206-5837
  • Jim Davies Oxford NIHR Biomedical Research Centre, UK Department of Computer Science, University of Oxford, Oxford, UK
  • Benjamin CT Field Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
  • Rajiv Gandhi Department of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
  • Sophie Harris Diabetes and Endocrinology Department, King’s College Hospital, UK
  • Kamlesh Khunti University Hospitals of Leicester NHS Trust, Diabetes Research Centre, Leicester General Hospital, Leicester, UK
  • Dinesh Nagi Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, UK
  • Parth Narendran Medical and Dental Sciences, University of Birmingham, Birmingham, UK Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  • Rustam Rea Oxford NIHR Biomedical Research Centre, UK Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, UK
  • Yue Ruan Oxford NIHR Biomedical Research Centre, UK Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, UK
  • Robert EJ Ryder Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  • Kinga A Várnai Oxford NIHR Biomedical Research Centre, UK Oxford University Hospitals NHS Foundation Trust, UK
  • Sarah H Wild Usher Institute, University of Edinburgh, Edinburgh, UK
  • Emma G Wilmot Diabetes Department, University Hospitals of Derby and Burton NHS FT, Derby, UK University of Nottingham, Nottingham, UK 16
  • Thinzar Min Department of Diabetes & Endocrinology, Singleton Hospital, Swansea Bay University Health Board, Swansea UK Department of Diabetes, Neath Port Talbot Hospital, Swansea Bay University Health Board, Neath, UK Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK.
  • Julia Platts Diabetes Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
  • Richard Chudleigh Department of Diabetes & Endocrinology, Singleton Hospital, Swansea Bay University Health Board, Swansea UK
  • Jeffrey W Stephens Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK. Department of Diabetes & Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
  • Sam Rice Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK. Diabetes Centre, Prince Philip Hospital, Hywel Dda University Health Board, Llanelli, UK

DOI:

https://doi.org/10.15277/bjd.2021.319

Keywords:

COVID-19, diabetes, Wales, United Kingdom

Abstract

Background: People with diabetes and coronavirus disease 2019 (COVID-19) have a significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19.

Methods: The ABCD COVID-19 and diabetes audit was a retrospective audit of patients admitted to UK hospitals with diabetes and COVID-19 between March and December 2020. Data related to patients admitted in Wales were compared with patients admitted in England and Scotland.

Results: In Wales, 40/82 (48.7%) patients with diabetes had COVID-19-related mortality compared with 1,149/2,916 (39.1%) in the UK group (p=0.08). The Welsh cohort were more likely to be Caucasian, have a higher body mass index and HbA1c, be diagnosed with diabetic retinopathy and prescribed a sodium-glucose co-transporter 2 inhibitor or insulin than those in England and Scotland. Patients admitted to the ICU in Wales were more likely to be male and have type 2 diabetes.

Conclusions: Patients admitted to hospital with diabetes and COVID-19 in Wales had a poorer outcome compared with England and Scotland. This disparity may reflect social inequality, differences in cardiovascular risk factors and/or differences in diabetes medications between hospitalised patients in Wales and the UK.

References

World Health Organisation. WHO Coronavirus (COVID-19) Dashboard. Available at: https://covid19.who.int/ [Accessed 13 July 2021].

Baumer T, Phillips E, Dhadda A, Szakmany T. Epidemiology of the first wave of COVID-19 ICU admissions in South Wales: the interplay between ethnicity and deprivation. Front Med (Lausanne) 2020;7:569714. https://doi.org/10.3389/fmed.2020.569714

Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 2020;8(10):823–33. https://doi.org/10.1016/S2213-8587(20)30271-0

Booth A, Reed AB, Ponzo S, et al. Population risk factors for severe disease and mortality in COVID-19: a global systematic review and meta-analysis. PLoS One 2021;16(3):e0247461. https://doi.org/10.1371/journal.pone.0247461

Woodward M, Peters SAE, Harris K. Social deprivation as a risk factor for COVID-19 mortality among women and men in the UK Biobank: nature of risk and context suggests that social interventions are essential to mitigate the effects of future pandemics. J Epidemiol Community Health 2021;75(11):1050–5. http://dx.doi.org/10.1136/jech-2020-215810

Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol 2020;8(10):813–22. https://doi.org/10.1016/S2213-8587(20)30272-2

Williams DM, Nawaz A, Evans M. Diabetes and novel coronavirus infection: implications for treatment. Diabetes Ther 2020;11:1915–24. https://doi.org/10.1007/s13300-020-00858-2

Nagi D, Ryder REJ, Ruan Y, et al. An audit of people admitted to hospital with diabetes and coronavirus (SARS-CoV-2): data collection methods. The Association of British Clinical Diabetologists (ABCD) Nationwide Audit. Br J Diabetes 2021;21(1):96–9. https://doi.org/10.15277/bjd.2021.299.

Oxford University Hospitals. Is my project research? Available from: https://www.ouh.nhs.uk/researchers/planning/is-it-research/ [Accessed 13 July 2021].

Foster HME, Celis-Morales CA, Nicholl BI, et al. The effect of socioeconomic deprivation on the association between an extended measurement of unhealthy lifestyle factors and health outcomes: a prospective analysis of the UK Biobank cohort. Lancet Public Health 2018; 3(12):e576-e585. https://doi.org/10.1016/S2468-2667(18)30200-7

Abel GA, Barclay ME, Payne RA. Adjusted indices of multiple deprivation to enable comparisons within and between constituent countries of the UK including an illustration using mortality rates. BMJ Open 2016; 6:e012750. http://dx.doi.org/10.1136/bmjopen-2016-012750

NHS Digital. 2020. National Diabetes Audit - Report 1. Care Processes and Treatment Targets 2018–19, Full Report. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/report-1-care-processes-and-treatment-targets-2018-19-full-report [Accessed 13 July 2021].

Public Health Wales. 2018. The case for action on obesity in Wales. Available at: https://phw.nhs.wales/topics/overweight-and-obesity/the-case-for-action-on-obesity-in-wales/ [Accessed 13 July 2021].

Welsh Government. 2019. Obesity Pathway. Available at: https://gov.wales/sites/default/files/publications/2019-06/obesity-pathway.pdf#:~:text=In%20Wales%2C%20as%20in%20many%20other%20countries%2C%20the,72%25%20and%2062%25%2C%20respectively%20among%2045-64%20year%20olds [Accessed 13 July 2021].

Gao M, Piernas C, Astbury NM, et al. Associations between body-mass index and COVID-19 severity in 6.9 million people in England: a prospective, community-based, cohort study. Lancet Diabetes Endocrinol 2021; 9(6):350–9. https://doi.org/10.1016/S2213-8587(21)00089-9

Cao P, Song Y, Zhuang Z, et al. Obesity and COVID-19 in adult patients with diabetes. Diabetes 2021;70(5):1061–9. https://doi.org/10.2337/db20-0671

Scheen AJ. SGLT2 inhibition during the COVID-19 epidemic: friend or foe? Diabetes Metab 2020;46(5):343–4. https://doi.org/10.1016/j.diabet.2020.06.003

Khunti K, Knighton P, Zaccardi F, et al. Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England. Lancet Diabetes Endocrinol 2021;9(5):293–303. https://doi.org/10.1016/S2213-8587(21)00050-4

Diabetes UK. The state of the nation 2019: a review of diabetes services in Wales. Available at: https://www.diabetes.org.uk/resources-s3/public/2020-06/SOTN%20report%20ENGLISH%5BW%5D_0.pdf?WQLn4oGFlPmQi3f_SQjptcKkAelHTXdn= [Accessed 13 July 2021].

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Published

2021-12-17

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Learning from practice

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