Impact of Covid-19 pandemic on patients with diabetes from Black Asian and minority ethnic community in a district general hospital

To study the glycaemic control and biopsychosocial effect on Black Asian and Minority Ethnic (BAME) patients with diabetes after contracting Covid-19 infection. Observational study of adult inpatients with diabetes admitted to a District General Hospital (DGH), from April 2020 to April 2021, with a positive PCR Covid-19 test. Demographical and biomedical data were collected before and after Covid-19 infection. We developed a psychosocial questionnaire to determine the effects of Covid-19 on depression, anxiety, health beliefs and quality of life. Data was analysed using a Mann-Whitney U or paired T-test depending on the normality of the data. Out of 213 Covid-19 positive inpatients with diabetes, only 32 (23 White British (WB) and nine BAME) remained after exclusion criteria. 87% of WB and 89% of BAME participants had type 2 diabetes. The mean pre Covid-19 body mass index (BMI) was 32 in both groups. Post Covid-19, there was no significant increase in HbA1c (p>0.05), BMI (p = 0.26), systolic (p = 0.98) and diastolic blood pressure (BP) (p = 0.29). There was no difference in the mean change, between WB and BAME participants, in HbA1c (WB 2.52, BAME 9.44, p = 0.54); BMI (WB 1.80, BAME 2.47, p = 0.77); systolic BP (WB 2.63, BAME 4.86, p = 0.79); and diastolic BP (WB 1.68, BAME 9.43, p = 0.25). Annual attendance to community diabetes review was the same in both participant groups (78%), highlighting equal access to community diabetes services. Both groups also had similar adherence to their diabetes medication with 87% WB and 89% BAME reporting 'always' adherent. More BAME (56%) than WB (26%) felt their diabetes care could be improved by further information about weight loss and diet. Similar percentages of WB (30%) and BAME (33%) felt their diabetes management had been impacted by Covid-19 due to deteriorating glucose control or declining symptoms because of contracting the virus. 56% BAME reported feeling scared living with diabetes compared to 35% WB. Similar percentages of BAME (67%) and WB (70%) reported that diabetes had no impact on their emotional wellbeing. Less BAME (33%) than WB (43%) reported being worried about future complications of diabetes. 78% BAME in contrast to 65% of WB participants did not feel depressed when thinking about living with diabetes. Contrary to available literature1-3, HbA1c, BP, and BMI of BAME participants with diabetes has not significantly worsened post COVID-19 infection, compared to WB participants in our DGH. During this time, the DGH had a fully functional diabetes service, despite the diabetes team supporting the Covid-19 wards too, which explains the unexpected, better results in BAME participants. Even though BAME felt more scared living with diabetes, WB reported worse psycho-emotional impacts caused by their diabetes diagnosis. Similar access to community diabetes services was observed in both groups, however more BAME than WB participates felt the quality of the diabetes services could be improved. Covid-19 did not have an expected negative impact on the care of BAME compared to WB participants and was not shown to worsen health inequalities in our population. Disparities in the risk and outcomes of COVID-19.pdf. https://assets.publishing.service.gov.uk/media/5f328354d3bf7f1b12a7023a/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf [Accessed 14 Feb 2024] Hayden MR. An Immediate and Long-Term Complication of COVID-19 May Be Type 2 Diabetes Mellitus: The Central Role of β-Cell Dysfunction, Apoptosis and Exploration of Possible Mechanisms. Cells. 2020 Nov 13;9(11):2475. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jun 19;69(24):759–65.