Physical effects of Covid-19 in patients with diabetes 1 year after hospitalisation in the UK: PHOSP-Covid study

Aim: To investigate the impact of Covid-19 on daily activity, maximal physical performance, and clinical frailty of people living with diabetes (any type) 1-year post-hospitalisation for Covid-19 in the UK. Method(s): This study is part of PHOSP-Covid, a multicentre long-term cohort study that recruited adults (>=18 years) who were discharged from one of the 83 NHS hospitals across the four UK nations following a clinical diagnosis of Covid-19 before March 31, 2021. We compared The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Incremental shuttle walk test (ISWT) distance (m), and clinical frailty (Rockwood frailty level), 5-month and 1-year after discharge in patients with and without diabetes. Result(s): Out of 2545 individuals (538 (21%) with diabetes), the proportion of individuals who classified as either 'mildly frail' or 'moderately or higher frail severity' was higher in individuals with diabetes (month 5: diabetes 9.9%, no diabetes 4.7%;month 12: diabetes 8%, no diabetes 4.9%). ISWT distance in patients with diabetes were significantly lower at both follow-ups but this measure improved from 5-months to 1-year (290 [95% CI: 190-440] vs 370 [250-560] for diabetes and 340 [210-450] vs 420 [270-590] for those without, both p < 0.01). At both time points, people with diabetes reported higher levels of fatigue (36 [24-44] vs 39 [25-46] at 5-month (p = 0.03);37 [26-45] vs 40 [28-47] at 1-year visit (p < 0.01)). Conclusion(s): One year after hospitalisation long Covid is more observed in people with diabetes.

Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21.

BACKGROUND: Coronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection. METHODS: A two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID. Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea. DISCUSSION: Ethical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals. TRIAL REGISTRATION: ClinicialTrials.gov NCT04900961 . Prospectively registered on 25 May 2021.

Awareness of Medical Professionals about Common Disinfectants in a Tertiary Care Hospital Against Corona Virus

Objective: To assess the working knowledge of health care workers (HCW) regarding the appropriate use of disinfectants against Coronavirus in hospital care settings using a questionnaire. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Lahore, Pakistan, from Apr 2020. Methodology: Two hundred health care workers were consecutively selected and divided into two groups, irrespective of gender. Each participant had to fill a structured proforma containing twenty-five close-ended questions. Result: Group-1 participants were 126 (63%) and group 2 participants were 74 (37%). 117 (92.8%) group-1 participants were 20–30 years of age and degree holders while 40 (54%) group-2 participants were 31-40 years old and diploma holders. Significant awareness (p<0.001) regarding disinfectants was observed in group-1 (102 81%);all the degree holders were well aware of disinfectants and required less training. In contrast, in group-2, 44 (59%) were fully aware of disinfectants;the rest did not qualify and needed proper training. Participants with a good educational status and work experience of >10 years were the high achievers in both groups. Conclusion: This study revealed that majority of the participants knew about the correct usage of disinfectants and they were fully prepared to handle the ongoing pandemic. Another finding was that awareness was directly related to relevant education, prolonged work experience and age. Keywords: Awareness, Disinfectants, Health care professionals. © 2022, Army Medical College. All rights reserved.

Change in risk factors in people with type 1 and type 2 diabetes over the covid-19 pandemic

Aims: To identify the change in HbA1c, body mass index (BMI) and systolic blood pressure (SBP) in people with type 1 and type 2 diabetes over the covid-19 pandemic. Methods: The change in time adjusted mean HbA1c, BMI and SBP between 2017/18 to 18/19, 2018/19 to 2019/20 and 2019/20 to 2020/21 were calculated for people with type 1 and type 2 diabetes included in the 2017/18, 2018/19, 2019/20 and 2020/21 National Diabetes Audits and still alive on 31st March 2021. Logistic regression models were created to assess the odds of having an increase in HbA1c ≥3mmol/mol, increase in BMI ≥1.0 kg/m2 and increase in systolic blood pressure ≥5 mmHg and odds ratios were converted to relative risks (RR). Results: After adjusting for age, sex, deprivation, and ethnicity in people with type 1 diabetes there was a significant decline in the odds of having an increase in HbA1c ≥3mmol/mol between 2019/20 to 2020/21 compared to between 2018/19 to 2019/20 (RR 0.86, 95% CI 0.85-0.86). Over the same time period the adjusted RR of someone with type 2 diabetes of having an increase in SBP ≥5 mmHg significantly increased (RR 1.11, 95% CI 1.10-1.11) compared to change between 2018/19 and 2019/20. Conclusions: There has been a modest decline in HbA1c in people with type 1 diabetes and an increase in SBP in people with type 2 diabetes in the year ending March 2021. Differential changes in other risk factors were less apparent and require further evaluation and may be biased due to reduced monitoring.

Incidence of type 1 and type 2 diabetes following hospitalisation for covid-19

Aims: To identify the incidence of type 1 and type 2 diabetes following hospitalisation for covid-19 in England. Methods: People aged ≥20 years admitted to hospital with covid-19 (ICD-10 codes U07.1, U07.2, U10) between 1st April and 31st August 2020 and discharged alive were followed to 31st March 2021. A comparator cohort ≥ 20 years age, admitted to hospital with pneumonia (ICD-10 codes J12-18) between 1st April 2019 and 31st August 2019 and discharged alive was followed to 31st March 2020. People diagnosed with diabetes prior to or within two weeks of discharge were excluded from the analysis. Incident diagnoses of type 1 diabetes and type 2 diabetes were identified through linkage with the National Diabetes Audit. Results: In 68,720 people admitted to hospital with covid-19, age and sex standardised incidence of type 1 diabetes and type 2 diabetes was 1.4 (95% CI 0.9-2.0 and 18.6 (95% 17.3-20.0) per 1000 person-years respectively. This is higher than the incidence in the general population between 1st April 2019 and 31st March 2020 (0.038 per 1000 person-years, 95% CI 0.036-0.040, for type 1 diabetes, 1.12 per 1000 person-years, 95% CI 1.11-1.13, for type 2 diabetes) but similar to those found in people discharged following hospitalisation for pneumonia (1.9 per 1000 person-years, 95% CI 1.4-2.4, for type 1 diabetes, 17.3 per 1000 person-years, 95% CI 16.1-18.5, for type 2 diabetes). Conclusions: Incidence of type 1 diabetes and type 2 diabetes following hospital admission with covid-19 is substantially higher than in the total population but is similar to that found in people previously hospitalised for pneumonia.