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

South African Family Practice

Field Value
Title Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study
Creator Aronson, Tatum Dave, Joel Ras, Tasleem
Subject Primary care; public health; family medicine COVID-19; diabetes mellitus; health systems; primary health care; intermediate care; family medicine; clinical risk classification
Description 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. 
Publisher AOSIS
Date 2023-02-13
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Quasi-experimental
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/safp.v65i1.5631
Source South African Family Practice; Vol 65, No 1 (2023): Part 1; 10 pages 2078-6204 2078-6190
Language eng
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Coverage Western Cape 2020 Age >65yrs, renal dysfunction, diabetic, with Covid-19
Rights Copyright (c) 2023 Tatum Aronson, Joel Dave, Tasleem Ras