Coronavirus disease (covid-19) mortality outcomes in a large teaching hospital in patients with diabetic foot ulceration: A retrospective observational cohort study

Background: We aim to examine the prevalence and management of hyperglycaemia in non-diabetic and diabetic ICU patients with covid-19. Methods: Retrospective study of 27 ICU patients with covid- 19 treated with dexamethasone. Results: Mean age 58yrs and 74% male: 26% female. Prevalence of pre-existing diabetes was 44% (12) while 56% (15) had no known history of diabetes. Type 2 diabetes accounted for all cases of pre-existing diabetes. In preceding 6 months 67% had no HbA1c check and 11.1% had an HbA1c on admission (all people with known diabetes). Ninety-three percent became hyperglycaemic (glucose >12 mmol/l) while in ICU. Mean peak glucose throughout admission for patients with pre-existing diabetes and those with no prior history were 18.5 mmol/l and 15.1 mmol/l, respectively. Of those with hyperglycaemia, 76% received insulin treatment: 92% of patients with pre-existing diabetes had some form of insulin treatment compared to 53% of patients with no prior history. Treatment regimens: actrapid infusion (73.7%), actrapid infusion with long-acting insulin (15.8%) and novorapid as required doses (10.5%). A third of patients required input from the diabetes team while on ICU. Conclusion: Our data shows that the majority of covid-19 patients treated with dexamethasone, regardless of diabetes history, develop hyperglycaemia and subsequently require insulin. HbA1c is not routinely performed on admission onto intensive care;however it is a useful tool in detecting undiagnosed diabetes at presentation, assessment of prior glycaemic control and degree of insulin resistance in patients with known diabetes. HbA1c measurement has implications for appropriate on-going management and long-term specialist input/follow-up.