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ABCD COVID-19 & Diabetes Audit

This audit is now completed though it did teach us a great deal as can be viewed here.

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.

At the time, many unanswered questions about the impact of COVID-19 on people with diabetes remained. ABCD therefore brought together a working group who would 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 aimed 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 hoped to gain better insight into the impact of COVID-19 on those living with diabetes.  The audit had a number of objectives.

Structure of the audit – centres and sites

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

Identification of cases

NHS hospital trusts had lists of COVID-19 cases and were able to generate lists of those with COVID-19 who had also been coded as having diabetes. Local pathology labs were also able to help with identification of cases. Once lists of cases had been generated, a number was allocated to each that was also used in the ABCD audit file. Then if there was a need to go back to the anonymised ABCD excel file later, it was possible to identify the case locally.

Collecting data

Depending on the individual Trust, in some instances the data collection was done using online records, in some cases the physical notes were required. Data collection for each patient typically took ~20-30 minutes.  It was found that junior doctors, registrars and medical students were keen to help collate data

Submitting data centrally

Anonymised data files could be securely transferred to Dr Rustam Rea and team in Oxford via NHS email to Email addresses that were not NHS were not allowed to be used. The team in Oxford lead on analysis of the national data, guided by the ABCD working group. The data submitted remained within the NHS. The data submitted centrally was anonymised. No patient identifiable data was submitted to Oxford.

Non ABCD members

Non ABCD members were welcome to take part in the audit and were given access to the data collection tool when they registered for the audit.

Register to take part in the audit and access to the on-line tool

When centres registered for the audit, the team sent out 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 were followed; we only to collected data from routine clinical practice, and analysis was of anonymised data.  The data was sent to Oxford University Hospitals NHS Foundation Trust (OUH) which hosted the anonymised data within a secure NHS haven. The Audit was registered with OUH and a Data Protection Impact Assessment was 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 emailed centres with dates for data submission with a countdown to submission at regular intervals. Data collection and analysis was a rolling process. The findings from the analysis were disseminated widely through national and international conferences and publications. Those who submitted data were acknowledged in the publications. Those who submitted the largest data sets were invited to be abstract and paper co-authors.

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

Audit Objectives

To see the audit objectives as they were when the audit was launched click here