Original Research Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study

Tatum Aronson, Joel Dave, Tasleem Ras

About the author(s) Tatum Aronson, Division of Family Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Joel Dave, Division of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Tasleem Ras, Division of Family Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

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Abstract

Background: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort.

Methods: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention.

Results: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p < 0.001), fewer antibiotics (p < 0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%).

Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress.

Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.

 

Keywords

COVID-19; diabetes mellitus; health systems; primary health care; intermediate care; family medicine; clinical risk classification

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