Risk factors for COVID-19 hospitalisation and death in people living with diabetes: A virtual cohort study from the Western Cape Province, South Africa

Abstract

Background COVID-19 outcomes and risk factors, including comorbidities and medication regimens, in people living with diabetes (PLWD) are poorly defined for low- and middle-income countries. Methods The Provincial Health Data Centre (Western Cape, South Africa) is a health information exchange collating patient-level routine health data for approximately 4 million public sector health care seekers. Data from COVID-19 patients diagnosed between March and July 2020, including PLWD, were analysed to describe risk factors, including dispensed diabetes medications and comorbidities, and their association with COVID-19 outcomes in this population. Findings There were 64476 COVID-19 patients diagnosed. Of 9305 PLWD, 44.9% were hospitalised, 4.0% admitted to ICU, 0.6% received ventilation and 15.4% died. In contrast, proportions of COVID-19 patients without diabetes were: 12.2% hospitalised, 1.0% admitted, 0.1% ventilated and 4.6% died. PLWD were significantly more likely to be admitted (OR:3.73, 95%CI: 3.53,3.94) and to die (OR:3.01, 95%CI: 2.76,3.28). Significant hospitalisation risk factors included HIV infection, chronic kidney disease, current TB, male sex and increasing age. Significant risk factors for mortality were CKD, male sex, HIV infection, previous TB and increasing age. Pre-infection use of insulin was associated with a significant increased risk for hospitalisation (OR:1·39, 95%CI:1·24,1·57) and mortality (OR1·49, 95%CI:1·27;1·74) and metformin was associated with a reduced risk for hospitalisation (OR:0·62,95%CI:0·55,0·71) and mortality (OR 0·77, 95%CI:0·64;0·92). Interpretation Using routine health data from this large virtual cohort, we have described the association of infectious and noncommunicable comorbidities as well as pre-infection diabetes medications with COVID-19 outcomes in PLWD in the Western Cape, South Africa. Funding This research was funded in part, by the Wellcome Trust 203135/Z/16/Z. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The Wellcome Centre for Infectious Diseases Research in Africa is supported by core funding from the Wellcome Trust [203135/Z/16/Z]. NT receives funding from the CIDRI-Africa Wellcome Trust grant (203135/Z/16/Z), and NT and TT receive funding from the NIH H3ABioNET award (U24HG006941). NT receives funding from the UKRI/MRC (MC_PC_MR/T037733/1)

Preadmission usage of metformin and mortality in COVID-19 patients including the post-discharge period

“…Metformin is contraindicated for patients with diabetes having comorbidities such as chronic kidney disease, which has a high risk for mortality. Therefore, metforminusable patients have a lower diabetic burden [25]. The exclusion of this group in our study provided a more accurate interpretation of the metformin effect.…”

“…After PSM, 120 MF( +) and 120 MF( −) patients were matched. ALT values (median(IQR)) of the MF ( +) group were higher than those of the MF (-) group (25(16-42) vs 19 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), p = 0.003). ICU admission rates, in-hospital mortality rates, and postdischarge mortality rates were higher in the MF( −) group, though not significant.…”

Active pulmonary tuberculosis and coronavirus disease 2019: A systematic review and meta-analysis

“…All studies evaluated data from retrospective patient cohorts, except for four (9.3%) that collected the information prospectively [ 39 , 40 , 56 , 69 ]. Six (14.0%) studies reported population-based data [ 35 , 36 , 42 , 52 , 59 , 62 ], while the others were conducted in a hospital setting. Two (4.7%) studies also included COVID-19 patients based on high clinical or radiological suspicion [ 39 , 44 ].…”

“…There was substantial heterogeneity between the studies ( I 2 94.7%). Baujat’s plot suggested that three studies unduly influenced heterogeneity as well as pooled estimates ( S1 Fig ) [ 36 , 59 , 62 ]. Omitting these three studies from meta-analysis resulted in a slightly higher summary estimate of proportion (1.15%, 95% CI 0.84%-1.50%) with only a minor reduction in heterogeneity ( I 2 86.9%).…”

A COVID-19 field hospital in a conference centre – The Cape Town, South Africa experience

“…The exceptionally high proportion of poorly controlled and newly diagnosed diabetics in our sample could explain the increased susceptibility of the population of Cape Town to the morbidity and mortality associated with COVID-19. 20 …”