Association of British Clinical Diabetologists

COVID-19 & Diabetes Nationwide Audit

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There is a bidirectional relationship between COVID-19 and diabetes. On the one hand, diabetes is associated with an increased risk of severe COVID-19. On the other hand, new-onset diabetes and severe metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolarity for which exceptionally high doses of insulin are warranted, have been observed in patients with COVID-19

Death in hospital

A third of people dying with COVID-19 in hospital in England had diabetes


Above:  Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycaemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycaemia (P < 0.001) - click to enlarge


Above: People with diabetes appear to be at increased risk of having a more severe COVID-19 infection, though evidence quantifying the increased risk is highly uncertain. The extent to which clinical and demographic factors moderate the relationship between diabetes and COVID-19 severity is entirely unclear due to a paucity of data  click to enlarge


Above: The death rate amongst confirmed cases of COVID-19 for patients with pre-existing diabetes was 9.2% click to enlarge


Above: In meta-analysis of six Chinese studies reporting incidence of diabetes in COVID-19 the Rate Ratio of more severe vs less severe infection in patients with diabetes was 2.26  click to enlarge


ABCD COVID-19 & Diabetes: UK national audit

COVID-19 and diabetes
Emerging data from the early stages of the COVID-19 pandemic identified that people with diabetes and COVID-19 had an elevated risk of adverse outcomes. The UK Government advice for people with diabetes was to stay at home as much as possible and follow strict social distancing. Despite these recommendations, sadly almost a third of the people who died during this pandemic in the UK had diabetes. Data from NHS England have identified that those with Type 1 and Type 2 diabetes have a 3.5- and 2- fold increased risk of excess death, respectively.

Many unanswered questions about the impact of COVID-19 on people with diabetes remain. ABCD has brought together a working group who aim to explore this relationship in more detail, through a national ABCD audit of those admitted with COVID-19 and diabetes.

About the ABCD COVID-19 & diabetes UK national audit
This audit aims to explore the clinical features and presentation of people admitted with diabetes and COVID-19. Through capturing detailed real-world data on the clinical presentation, co-morbidities, therapies and outcomes we hope to gain better insight into the impact of COVID-19 on those living with diabetes.  The audit has a number of objectives.

Structure of the audit centres and sites
For this audit, the concept of centres and sites is utilised in the same way as in the other ABCD audits. Typically, a centre is an NHS Trust. Designated leaders of the local audit are given access to the anonymised data of all the patients associated with the centre for more powerful local analysis. Findings from local analysis can be put forward for further testing on the full national dataset.

Identification of cases
Your trust will have a list of COVID-19 cases and may be able to generate a list of those with COVID-19 who have also been coded as having diabetes. If this is not possible your local pathology lab may be able to help with identification of cases. Once you have a list of cases, please allocate a number to each that will also be used in the ABCD audit file. Then if you need to go back to the anonymised ABCD excel file later you will be able to identify the case locally.

Collecting data
We are now past the first peak of COVID-19 and it is therefore likely that most data collection will be retrospective. It is recommended that data is collected on consecutive cases. Each centre registered for the audit should aim to submit a minimum of 10 cases (there is no upper limit). In centres which have started collecting data for the audit we have found that junior doctors, registrars and medical students have been keen to help collate data. Depending on the individual trust, in some instances the data collection can be done using online records, in some cases the physical notes will be required. Data collection for each patient typically takes ~20-30 minutes.

Submitting data centrally
Anonymised data files can be securely transferred to Dr Rustam Rea and team in Oxford via NHS email to Email addresses that are not NHS should not be used. The team in Oxford will lead on analysis of the national data, guided by the working group. The data submitted will remain within the NHS. The data submitted centrally will be anonymised. No patient identifiable data should be submitted to Oxford.

Non ABCD members
Non ABCD members are welcome to take part in the audit and will be given access to the data collection tool when they register for the audit.

Register to take part in the audit and access to the on-line tool
When you register for the audit, the team will send you the Excel file for data collection.

Caldicott Guardian approval and information governance
The ABCD nationwide audit programme has Caldicott Guardian approval. The programme is audit not research. The NHS encourages audit of clinical practice and there are strict guidelines which we follow, we only to collect data from routine clinical practice, and analysis is of anonymised data.  The data will be sent to Oxford University Hospitals NHS Foundation Trust (OUH) which will host the anonymised data within a secure NHS haven. The Audit has been registered with OUH and a Data Protection Impact Assessment has been completed and signed by the Caldicott Guardian of OUH. Further information regarding Information Governance can be obtained by emailing

Data analysis and dissemination
The audit team will email you with dates for data submission with a countdown to submission at regular intervals. Data collection and analysis will be a rolling process. The findings form the analysis will be disseminated widely through national and international conferences and publications. Those who submit data will be acknowledged in the publications. Those who submit the largest data sets shall also be invited to be abstract and paper co-authors.

Further information
Further enquiries may be made to the ABCD nationwide audits database administrator of the project,
Melissa Cull

ABCD COVID-19 & Diabetes national audit team
Dr Rustam Rea
Prof Kamlesh Khunti
Prof Sarah Wild
Dr Bob Ryder
Dr Emma Wilmot
Dr Ben Field
Dr Parth Narendran
Dr Rajev Ghandi
Dr Sophie Harris
Dr Dinesh Nagi


Register for the COVID-19 & Diabetes audit

Audit objectives

Papers, abstracts, presentations, posters from the audit

Further information- contact us

Main ABCD homepage

The ABCD nationwide COVID-19 & Diabetes is an independent audit which has received support from Public Health Wales and Novo Nordisk

Working to support high quality diabetes care in the UK