Prevalence of pre-diabetes, newly diagnosed diabetes, and associated COVID-19 disease severity in patients hospitalized at Sir Ketumile Masire Teaching Hospital, Botswana

Background The mechanism of diabetes with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and onset in COVID-19 patients remains unclear. We aimed to determine the prevalence of pre-diabetes and newly diagnosed diabetes, and to assess their association with COVID-19 disease severity in patients admitted to Sir Ketumile Masire Teaching Hospital (SKMTH), Botswana. Methods We conducted a single-center, retrospective cross-sectional study at SKMTH. A random sample of 100 adult patient records was reviewed from 992 eligible admissions with laboratory-confirmed COVID-19 between June 2020 and June 2021. Patients with a known history of diabetes were excluded. Participants were classified as normoglycemic, pre-diabetic, or newly diagnosed diabetic based on their first available laboratory results, primarily HbA1c, during admission. Univariate and multivariable Poisson regression was used to identify factors associated with severe COVID-19 disease and mortality. Results Among 100 patients, 73% were male, with a mean age of 49.5 years (Standard deviation 13.7). Hypertension (34%) and HIV infection (24%) were the most prevalent comorbidities. Pre-diabetes was detected in 35% (95%CI:25.7–45.2) and newly diagnosed diabetes in 43% (95% CI: 33.1–53.6) of participants. Having diabetes increased the risk of severe COVID-19 [adjusted Relative Risk (aRR)=5.74; 95%CI:1.31–25.2, p=0.02]. Sepsis was also an independent predictor (aRR=5.90; 95% CI:1.83–18.7, p=0.003). In contrast, male sex was associated with a reduced risk of severe disease compared with females (aRR=0.40; 95% CI:0.16–1.0, p=0.05). HIV, hypertension, and alcohol use were not significantly associated with severe disease. Residing in rural areas was associated with a reduced risk of severe disease (aRR=0.41; 95%CI:0.15-1.10). Of the 98 participants with available outcome data, 44 (44.9%) died during hospitalization, and 54 (55.1%) were discharged alive. Newly diagnosed diabetes was associated with increased in-hospital mortality in both univariable (RR = 3.45, 95% CI: 1.17–10.21; p=0.025) and multivariable analyses (aRR=3.71, 95%CI:1.49–9.26; p=0.005). Conclusion There was a high burden of previously undiagnosed pre-diabetes and diabetes among COVID-19 inpatients in Botswana. Among hospitalized COVID-19 patients without previously known diabetes, newly diagnosed diabetes was associated with a higher risk of severe disease and poor in-hospital outcomes, highlighting the importance of integrating routine diabetes screening into COVID-19 care pathways.