Hyperglycaemia, diabetes mellitus and COVID-19 in a tertiary hospital in KwaZulu-Natal
Background: Despite a substantial diabetes mellitus (DM) burden, there are few data regarding the relationship between DM and hyperglycaemia on COVID-19 severity and outcome in African populations. This study aimed to describe this relationship in the local context, and to determine whether our data correlated with observations made globally.
Methods: Retrospective analysis of patients admitted to King Edward VIII Hospital with COVID-19 during June September 2020 was undertaken. The sample was subdivided into three cohorts: DM; hyperglycaemia only (HO); and neither DM nor hyperglycaemia (NDNH). Patients living with DM (PLWD) were further subdivided into those with hyperglycaemia (PLWDH) versus normoglycaemia (PLWDN). Comparisons were made across groups.
Results: The 236 participants enrolled comprised 79 with DM, 22 with HO, and 135 with NDNH. Half of patients with HO, 26.6% of PLWD and 15.6% of NDNH died. A log-rank test revealed significantly lower survival rates for those with HO compared with PLWDN (p = 0.001) and NDNH (p = 0.002). PLWDH also had significantly lowe survival rates when compared with these two groups (p = 0.018 and p = 0.039 respectively). PLWD were significantly more likely to receive steroids (odds ratio [OR] 2.03) and oxygen therapy (OR 2.93). Patients with HO were significantly more likely to receive mechanical ventilation (MV) (OR 7.7) and die (OR 5.43). Compared with PLWDN, PLWDH were significantly more likely to receive MV (OR 10.83) and die (OR 4.24). When compared with PLWDN, patients with HO were significantly more likely to receive oxygen (100% vs. 70.4%), MV (63.6% vs. 3.7%) or die (50% vs. 11.1%).
Conclusion: This study concurred with global findings, highlighting the importance of glycaemia as a prognostic marker in patients hospitalised with COVID-19. We recommend that all patients admitted with COVID-19 have a random glucose on admission and strict glycaemic control in those with hyperglycaemia to improve outcomes.