A recent study found that patients with undiagnosed diabetes represented 21.1% of all Covid-19 hospitalisations and 30.5% of all Covid-19 deaths across eight low- and middle-income eight countries, including South Africa.
The research focused on China, Brazil, India, Indonesia, Mexico, Pakistan, Nigeria and South Africa, and the findings were published in The Lancet.
While patients with Covid, who had diagnosed chronic diseases – including diabetes – were likely to experience higher rates of hospitalisation and mortality relative to the general population, said the scientists, the burden of undiagnosed co-morbidities during the pandemic, however, had not been adequately studied.
For the study, they had established a model to estimate the hospitalisation and mortality burden of patients with Covid-19 who had undiagnosed type 1 and type 2 diabetes.
They found that across the eight countries, 6.7m patients admitted to hospital with Covid had undiagnosed diabetes, of whom 1.9m died. They represented 21.1% of all Covid hospitalisations and 30.5% of all Covid deaths in these countries.
In the first stage of the pandemic – before a country reached a 1% population vaccination rate with one dose of a Covid-19 vaccine – South Africa, for instance, recorded a total of 1 338 319 hospital admissions, of whom 222 396 had diagnosed diabetes and 209 547 were undiagnosed. There were 183 930 deaths, of whom 36 716 were diagnosed diabetics, and 41 360 were undiagnosed.
Preventable deaths
“If populations in these countries had been diagnosed with diabetes before the pandemic, 1.7% of Covid-19 hospitalisations and 5.0% of the deaths could have been prevented, and 1.8m quality adjusted life years (QALY) gained,” the authors said.
The study notes that an understanding of the risk factors driving severe Covid-19 outcomes could lead to targeted investments in prevention and control efforts to reduce health system burdens during future pandemic waves.
The authors said that the growing burden of non-communicable diseases (NCD) called for urgent and increased investments in prevention and diagnostics.
“NCDs can severely increase the health burden caused by new and emerging infectious diseases,” they warned, adding that a meta-analysis had found diabetes to be the third most common comorbidity associated with higher Covid-19 severity and mortality after hypertension and obesity.
However, accounting of diabetes in patients with Covid-19 has focused on populations with known diabetes, potentially excluding the 45% of individuals with diabetes globally who are unaware of their status.
“Non-communicable diseases, specifically diabetes, obesity and hypertension, are rapidly growing in LMICs, afflicting a serious health and economic burden. Their importance was magnified during the pandemic. This study highlights the benefits of prevention of diabetes cases, and the importance of timely diagnosis to reduce future disease burdens.”
Study details
Estimates of hospitalisations and deaths in patients with COVID-19 associated with undiagnosed diabetes during the first phase of the pandemic in eight low-income and middle-income countries: a modelling study
Amit Summan, Arindam Nandi, Beatrice Vetter et al.
Published in The Lancet on 5 March 2024
Summary
Background
Patients with Covid-19 who had diagnosed chronic diseases – including diabetes – may experience higher rates of hospitalisation and mortality relative to the general population. However, the burden of undiagnosed co-morbidities during the pandemic has not been adequately studied.
Methods
We developed a model to estimate the hospitalisation and mortality burden of patients with Covid-19 that had undiagnosed type 1 and type 2 diabetes (UD). The retrospective analytical modelling framework was informed by country-level demographic, epidemiological and Covid-19 data and parameters. Eight low-and middle-income countries (LMICs) were studied: Brazil, China, India, Indonesia, Mexico, Nigeria, Pakistan, and South Africa. The modelling period consisted of the first phase of the pandemic — starting from the date when a country identified its first Covid case to the date when the country reached 1% coverage with one dose of a vaccine. The end date ranged from Jan 20, 2021 for China to June 2, 2021 for Nigeria. Additionally, we estimated the change in burden under a scenario in which all individuals with UD had been diagnosed prior to the pandemic.
Findings
Based on our modelling estimates, across the eight countries, 6.7 (95% uncertainty interval: 3.4–11.3) million Covid-19 hospitalised patients had UD of which 1.9 (0.9–3.4) million died. These represented 21.1% (13.4%–30.1%) of all Covid-19 hospitalisations and 30.5% (14.3%–55.5%) of all Covid-19 deaths in these countries. Based on modelling estimates, if these populations had been diagnosed for diabetes prior to the Covid-19 pandemic, 1.7% (−3.0% to 5.9%) of Covid-19 hospitalisations and 5.0% (−0.9% to 14.1%) of Covid-19 deaths could have been prevented, and 1.8 (−0.3 to 5.0) million quality-adjusted life years gained.
Interpretation
Our findings suggest that undiagnosed diabetes contributed substantially to Covid-19 hospitalisations and deaths in many LMICs.
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10th edition of IDF Diabetes Atlas: One in nine SA adults living with diabetes
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