Almost half of patients in hospital for Covid are diabetic - research

A YEAR of research by professors at Groote Schuur Hospital has determined that people living with diabetes, especially Type 2 diabetes, are at risk for more severe Covid-19 complications and have a greater chance of being admitted to the intensive care unit (ICU) or have acute kidney injury.

During the first wave of the pandemic in the Western Cape, 45% of patients with Covid-19 who were admitted to hospital had diabetes.

This is according to Professor Joel Dave, head of the Division of Endocrinology at Groote Schuur Hospital, who was part of the panel of researchers.

“The pandemic in South Africa began in March 2020, so for the past 12 months, many researchers at Groote Schuur Hospital have been analysing clinical data in an attempt to understand how this virus behaves in our population and to try and identify those people most at risk for more severe disease,” said Professor Dave.

Current estimates are that there are about 4.6 million people living with diabetes in South Africa, with about 300,000 to 400,000 accessing their healthcare in the public sector in the Western Cape.

The International Diabetes Federation has estimated that, in South Africa, about 52% of people who have diabetes are undiagnosed and therefore do not yet know they have diabetes.

Professor Dave said that the key for people living with diabetes to stay safe during this time was to ensure that their condition is well-controlled and to adhere to all the recommended prevention measures such as wearing a mask, physical distancing and regularly using hand sanitiser.

It is for this reason that Professor Dave suggested that people living with diabetes should try and stay at home as much as possible until they are vaccinated.

He outlined that often diabetes could be prevented if people adhered to a healthy lifestyle.

“It’s very important to aim for a normal body mass index, to exercise, to limit intake of carbohydrates and to not eat any sugar,” he said.

In addition to this, the professor said it was important for people living with diabetes to regulate it, to prevent complications. He added that “medication and lifestyle” were both essential for this.

The professor said that he hoped the data and findings would motivate people living with diabetes to strive for improved diabetes control and to create awareness for those that are at risk for developing diabetes to try and improve their lifestyle, especially while living during a pandemic.

“People living with diabetes are at greater risk for any infection because they have a dysregulated immune system,” said Dave.

He explained that there was no proof to suggest that people with diabetes had a greater risk of contracting Covid-19 but when infected, they are more likely to have severe symptoms or land up in ICU

“There is currently no data to suggest that people living with diabetes are at greater risk of being infected by SARS-CoV-2 but data from around the world, including South Africa, shows that once people living with diabetes are infected with SARS-CoV-2 they are at risk for more severe Covid-19 with a greater risk of being admitted to hospital and for needing an intensive care unit,” he said.

Professor Dave said additional risk factors that many people living with diabetes may have was that they are usually older and are more likely to be overweight or obese, with many studies having shown that older age, above 60 years of age, and obesity are independent risk factors for more severe Covid-19 symptoms.

In addition to this, he said people living with diabetes often have some degree of chronic kidney disease (CKD) and CKD was a major risk factor for more severe Covid-19.

Processor Nicola Wearne, nephrologist at Groote Schuur Hospital, said that people generally had a high mortality rate once they had acute kidney injury due to SARS-CoV-2.

“Acute kidney injury in Covid-19 has a high mortality,” detailed Wearne.

“Should the patient survive and have end-stage kidney disease requiring chronic renal replacement therapy, then they will be assessed at the Renal Replacement Program Meeting for eligibility for chronic dialysis.”

The virus has also been attributed to longer hours of work for staff like Professor Dave.

He added that teamwork was essential for an effective and cohesive response to this pandemic.

“Working hours for many doctors increased during the first and second wave of the Covid-19 pandemic,” said Professor Dave.

“Many doctors had to leave their usual clinical duties and join the Covid-19 Clinical service.

“There were different teams on call during the day and night resulting in an increase in after hours work, with a new team of doctors coming on duty every 8 hours, with one team even coming on duty at midnight and continuing until 8am.”