A significant number of studies invoked diabetes as a risk factor for virus infections, but the issue remains controversial. We aimed to examine whether non-autoimmune diabetes mellitus enhances the risk of virus infections compared with the risk in healthy individuals without non-autoimmune diabetes mellitus. In this systematic review and meta-analysis, we assessed case-control and cohort studies on the association between non-autoimmune diabetes and viruses. We searched PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science with no language restriction, to identify articles published until February 15, 2021. The main outcome assessment was the risk of virus infection in individuals with non-autoimmune diabetes. We used a random-effects model to pool individual studies and assessed heterogeneity (I2) using the χ2 test on Cochrane’s Q statistic. This study is registered with PROSPERO, number CRD42019134142. Out of 3136 articles identified, we included 68 articles (90 studies, as the number of virus and or diabetes phenotype varied between included articles). The summary OR between non-autoimmune diabetes and virus infections risk were, 10.8(95% CI: 10.3–11.4; 1-study) for SARS-CoV-2; 3.6(95%CI: 2.7–4.9, I2 = 91.7%; 43-studies) for HCV; 2.7(95% CI: 1.3–5.4, I2 = 89.9%, 8-studies;) for HHV8; 2.1(95% CI: 1.7–2.5; 1-study) for H1N1 virus; 1.6(95% CI: 1.2–2.13, I2 = 98.3%, 27-studies) for HBV; 1.5(95% CI: 1.1–2.0; 1-study) for HSV1; 3.5(95% CI: 0.6–18.3 , I2 = 83.9%, 5-studies) for CMV; 2.9(95% CI: 1–8.7, 1-study) for TTV; 2.6(95% CI: 0.7–9.1, 1-study) for Parvovirus B19; 0.7(95% CI: 0.3–1.5 , 1-study) for coxsackie B virus; and 0.2(95% CI: 0–6.2; 1-study) for HGV. Our findings suggest that, non-autoimmune diabetes is associated with increased susceptibility to viruses especially SARS-CoV-2, HCV, HHV8, H1N1 virus, HBV and HSV1. Thus, these viruses deserve more attention from diabetes health-care providers, researchers, policy makers, and stakeholders for improved detection, overall proper management, and efficient control of viruses in people with non-autoimmune diabetes.

BackgroundSeveral epidemiological studies have established the association between hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM). However, the determinants and reasons for the high prevalence of HCV infection in people with T2DM are not well understood especially in sub-Saharan African populations. In this study, we aimed to assess determinants of the association between HCV infection and T2DM.MethodsWe performed a cross-sectional study amongst 442 T2DM patients recruited from an out-patient adult diabetes clinic in a tertiary hospital and 442 non-diabetic controls recruited from the general population. Serological testing for HCV antibody was performed using standard ELISA technique. Anti-HCV antibody prevalence was reported by age group in participants with diabetes and the non-diabetic controls. Logistic regression was used to examine for factors associated with the HCV infection in patients with diabetes.ResultsWe reported an overall HCV prevalence of 11.5% [95% CI: 9.4-13.6] irrespective of diabetes status in this study. The seroprevalence of HCV infection in diabetics patients was 17.6% [95% CI: 14.0-21.2] compared to 5.5% [95% CI: 3.4-7.6] in non-diabetics (p< 0.001). We did not find a significant HCV seropositivity difference in diabetic patients with common risk factors of HCV infection. When investigating the HCV seroprevalence by age group in diabetic and non-diabetic patients, no case of HCV infection was found in patients less than 30 years old while the highest HCV seropositivity was reported in patients older than 60 years (36.7% T2DM and 11.1% for non-diabetics) followed by the patients belonging to 50-59 years age group (16% in T2DM and 5.8% in non-diabetics) and those in 40-49 years age group (4.4% in diabetic, 0.8% in non-diabetic). To support this finding, in a multivariate logistic regression, only diabetic patients belonging to age group > 65 years had a significant risk (OR: 16.7 [95% CI: 1.7-160.0]) to acquire HCV infection.ConclusionThe seroprevalence of HCV infection is higher among T2DM adult patients than in non-diabetic patients, and is associated with increased age. This age-dependent association may suggest a generational exposure that may no longer exist overtime.