AUTHOR=Tee Louis Y. , Alhamid Sharifah Munirah , Tan Jeriel L. , Oo Theik Di , Chien Jaime , Galinato Primavera , Tan Seow Yen , Humaira Shafi , Fong Raymond Kok Choon , Puar Troy H. , Loh Wann Jia , Santosa Anindita , Khoo Joan , Rosario Barbara Helen 

TITLE=COVID-19 and Undiagnosed Pre-diabetes or Diabetes Mellitus Among International Migrant Workers in Singapore

JOURNAL=Frontiers in Public Health

VOLUME=Volume 8 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2020.584249

DOI=10.3389/fpubh.2020.584249

ISSN=2296-2565

ABSTRACT=Objective
Migrant workers, a marginalized and under-resourced population, are vulnerable to coronavirus disease 2019 (COVID-19) due to limited healthcare access.  Moreover, metabolic diseases – such as diabetes mellitus (DM), hypertension and hyperlipidemia – predispose to severe complications and mortality from COVID-19.  We investigate the prevalence and consequences of undiagnosed metabolic illnesses, particularly DM and pre-diabetes, in international migrant workers with COVID-19.

Methods 
In this retrospective analysis, we analyzed the medical records of international migrant workers with laboratory-confirmed COVID-19 hospitalized at a tertiary hospital in Singapore from April 21 to June 1, 2020. We determined the prevalence of DM and pre-diabetes, and analyzed the risk of developing complications, such as pneumonia and electrolyte abnormalities, based on age and diagnosis of DM and pre-diabetes.

Results
240 male migrant workers, with mean age of 44.2 years (standard deviation [SD], 8.5years), were included.  21 patients (8.8%) were diagnosed with pre-diabetes, and 19 (7.9%) with DM. DM was poorly controlled with a mean HbA1c of 9.9% (SD, 2.4%).  73.7% of the patients with DM and all the patients with pre-diabetes were previously undiagnosed. Pre-diabetes was associated with higher risk of pneumonia (odds ratio [OR], 10.8, 95% confidence interval [CI], 3.65 to 32.1; P less than 0.0001), hyponatremia (OR, 8.83; 95% CI, 1.17 to 66.6; P=0.0342), and hypokalemia (OR, 4.58; 95% CI, 1.52 to 13.82; P=0.0069).  Moreover, patients with DM or pre-diabetes developed COVID-19 infection with lower viral RNA levels.

Conclusions
The high prevalence of undiagnosed pre-diabetes among international migrant workers increases their risk of pneumonia and electrolyte abnormalities from COVID-19.