Comparing between survived and deceased patients with Diabetes Mellitus and COVID-19 in Bangladesh: A cross sectional study from a COVID-19 dedicated hospital
Summary (1 min read)
Introduction
- The ongoing pandemic of coronavirus disease 2019 (COVID-19) is one of the greatest disasters that the world has ever witnessed.
- While the clinical spectrum of COVID-19 is highly variable, the disease severity and mortality were reported to be significantly higher among patients with comorbidities, particularly diabetes mellitus (DM) [1, 2] .
- India, Pakistan, and Bangladesh are among the top 10 countries globally by the number of affected people and undiagnosed cases [3] .
- Moreover, studies comparing survived and diseased patients with DM and COVID-19 are rare in literature, which the authors believe is vital to identify cases requiring urgent clinical attention.
- This study aimed to address the clinical epidemiology and outcome of COVID-19 patients with DM in Bangladesh, along with a detailed comparison between survived and deceased.
Methods
- This retrospective cross-sectional observational study was conducted among RT-PCR confirmed COVID-19 patients with pre-existing DM admitted from 1 to 30 June 2020 in a specialized COVID-19 hospital (Kurmitola General Hospital) located in Dhaka, the epicenter of the COVID-19 pandemic in Bangladesh.
- Patients with known DM and taking antidiabetic agents were considered to have pre-existing DM.
- The severity of COVID-19 was described by WHO interim guidance [4] .
- Data were extracted from hospital records using a relevant questionnaire.
- All information was double-checked before analysis to ensure quality.
Results
- A total of 921 RT-PCR confirmed COVID-19 patients were admitted to the hospital during the study period.
- The glycemic status was poor in both survived and deceased patients; median HbA1c was 8.3% and 8.6%, respectively.
- Interestingly, hospital days were significantly higher among survivors (13 vs 5 days, p <0.001).
Discussion
- The authors study found that one in four hospitalized patients (235/921) with COVID-19 had preexisting DM.
- The prevalence showed wide variability in other countries ranging from 5.3% in China to 33% in Europe and nearly 50% in India [1, 6] .
- Significantly higher NLR and serum ferritin levels among non-survivors compared to survivors were reported in already published studies [10, 11] .
- While ICU support was indicated in over 30% (72/231) of diabetic patients, more than half of them (43/72) could not be admitted into ICU due to the acute bed crisis (only a ten bedded ICU support in the study hospital).
- The authors believe this is a unique finding for resource-poor settingsand needs further research.
Conclusions
- The authors study found deceased patients with DM and COVID-19 had significantly lower oxygen saturation and significantly higher NLR, RBG and serum ferritin levels compared to survived.
- The authors believe findings from this study will help clinicians to identify a subgroup of diabetic patients with COVID-19 who are at higher risk of in-hospital death; hence, requiring rigorous clinical management.
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Frequently Asked Questions (6)
Q2. What are the future works mentioned in the paper "Comparing between survived and deceased patients with diabetes mellitus and covid-19 in bangladesh: a cross sectional study from a covid-19 dedicated hospital" ?
The authors believe this is a unique finding for resource-poor settingsand needs further research.
Q3. What was the prevalence of DM in Bangladesh?
Patients having glycated hemoglobin (HbA1c) ≥6.5% done within three months of admission were also included as having pre-existing DM.
Q4. How many patients were admitted to the ICU?
While ICU support was indicated in over 30% (72/231) of diabetic patients, more than half of them (43/72) could not be admitted into ICU due to the acute bed crisis (only a ten bedded ICU support in the study hospital).
Q5. How many patients with DM got ICU support?
While intensive care unit (ICU) support was indicated for 31.2% (72/231) patients with DM, only 12.5% (29/231) of them got ICU admission (Fig 1).
Q6. What is the main reason for the study?
The authors believe findings from this study will help clinicians to identify a subgroup of diabetic patients with COVID-19 who are at higher risk of in-hospital death; hence, requiring rigorous clinical management.