Endocrine Abstracts

Background: The prevalence rate of Diabetes within Manchester is higher than the national average of England. Association of British Clinical Diabetologists (ABCD) guidance highlights an increased risk of typical and atypical presentations of diabetic emergencies in patients with Diabetes and COVID-19. In the absence of early recognition and treatment, this could lead to adverse outcomes and poor prognosis, thus leading to increased mortality rates.

Aims: The aims involved evaluation of outcomes in patients with diabetes and concurrent Covid-19 infection followed by identification of compliance with the ABCD front door guidance for immediate management of these cohort of patients, in order to improve clinical care.

Methods: We collected clinical data on a retrospective basis from electronic records of patients admitted to our centre with a diagnosis of Covid-19 and Diabetes Mellitus between January and July 2020. Patients were identified using coding within Discharge Notification Forms (DNFs).

Results: Thirty-four (34) patients were selected to create our sample population. Thirty-one (91.2%) patients had a recorded blood glucose on admission. Two (5.9%) patients had blood ketone levels recorded on admission. The median and mean blood glucose on admission was Ten point one (10.1 mmol/l) and Twelve point four (12.4 mmol/l), respectively. Metformin was withheld in five (5) out of Sixteen (equating to 31.9%) patients taking on admission, pending review of the biochemical and hypoxic status. Sodium-Glucose Transport Protein 2 (SGLT-2) inhibitors were appropriately withheld in all Thirty-four (equating to 100%) patients on admission. Out of the entire cohort of patients, eleven (equating to 32.3%) did not survive admission.

Conclusions: Severe Covid-19 is associated with significant morbidity and mortality. Data from this single centre audit suggests that a large proportion of patients with diabetes and diagnosis of Covid-19 are at risk of hyperglycaemia with ketosis at time of admission, yet only a small number have a recorded ketone level. Steps should be taken to improve awareness and education of admitting clinicians to identify and reduce the risk of possible diabetic emergencies within this high-risk cohort of patients. In addition to this, it is also recommended that in this group of patients, health care professionals must consider additional safety measures, namely review of medications such as SGLT-2 inhibitors and Metformin on admission, which in turn is likely to improve outcomes and prognosis of these patients. Following the acute phase, Metformin needs to be reviewed on the basis of the biochemical and Respiratory status of the patient.