Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals

Izzi‐Engbeaya, Chioma; Distaso, Walter; Amin, Anjali; Yang, Wei; Idowu, Oluwagbemiga; Kenkre, Julia; Shah, Ronak J; Woin, Evelina; Shi, Christine; Alavi, N; Bedri, Hala; Brady, Niamh; Blackburn, Sophie; Leczycka, Martina Eva; Patel, Suhani; Sokol, Elizaveta; Toke‐Bjolgerud, Edward; Qayum, A; Abdel-Malek, Mariana; Hope, David; Oliver, Nick; Bravis, Vassiliki; Misra, Shivani; Tan, Tricia; Hill, Neil; Salem, Victoria

doi:10.1136/bmjdrc-2020-001858

Cited by 56 publications

(50 citation statements)

References 32 publications

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“…A study in Korea reported neutrality for COVI-19 mortality (OR 0.84; 95% CI, 0.23–3.09) in SUs users vs. non-users [ 23 ]. A similar result was reported by Izzi-Engbeaya for deaths within 30 days (OR 0.66; 95% CI, 0.30–1.52) in univariate analysis [ 24 ] and by Silverii and colleagues [ 25 ]. The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study also found a neutral effect of SUs/glinides on mortality (OR 0.83; 95% CI, 0.67–1.03) within 28 days [ 26 ].…”

Section: Sulphonylureassupporting

confidence: 86%

Managing diabetes in diabetic patients with COVID: where do we start from?

2021

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Aims COVID-19 has and still is sweeping away the national health systems worldwide. In this review, we sought to determine the evidence base proofs on the antidiabetic treatment capable to reduce the risk of COVID-19-related mortality. Methods We have performed a systematic search of published articles using PubMed, and EMBASE from March 2020 to March 31st, 2021. We excluded editorials, commentary, letters to the editor, reviews, and studies that did not have mortality as an outcome. For metformin and insulin only, we performed a meta-analysis using Cochrane RevMan 5.2. Results Among antidiabetic drugs, metformin was the only drug associated with a reduced risk of mortality. Conversely, insulin appears associated with an increased risk. The other classes of drugs were neutral. Conclusions The totality of articles reports retrospective data strongly affected by “channeling bias” so that most of the existing results on each class of drugs are driven by the phenotype of patients likely to receive that specific drug by prescription.

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Section: Sulphonylureassupporting

confidence: 86%

Managing diabetes in diabetic patients with COVID: where do we start from?

2021

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“…Seven studies (13.5%) reported the unadjusted effect of frailty based on the CFS with delirium (OR 2.91; 95% CI 2.00–4.25; I 2 = 56%; Figure S6). 29,40,43,48,58,64,69 Eight studies (15.4%) reported an unadjusted association of frailty based on the CFS with ICU admission 8,23,28,29,39,40,43,69 (OR 0.24, 95% CI 0.08–0.71; I 2 = 92%; Figure S7), and three studies (5.8%) reported the adjusted association 8,67,69 (OR 0.87, 95% CI 0.56–1.35; I 2 = 69%; Figure S8). Six (11.5%) studies reported unadjusted associations between frailty based on the CFS and receipt of mechanical ventilation (OR 0.32, 95% CI 0.08–1.30; I 2 = 89%; Figure S9).…”

Section: Resultsmentioning

confidence: 99%

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

Dumitrascu

Branje

Hladkowicz

et al. 2021

J American Geriatrics Society

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Background and Objectives: Frailty leaves older adults vulnerable to adverse health outcomes. Frailty assessment is recommended by multiple COVID-19 guidelines to inform care and resource allocation. We aimed to identify, describe, and synthesize studies reporting the association of frailty with outcomes (informed by the Institute for Healthcare Improvement's Triple Aim [health, resource use, and experience]) in individuals with COVID-19.Design: Systematic review and meta-analysis. Setting: Studies reporting associations between frailty and outcomes in the setting of COVID-19 diagnosis. Participants: Adults with COVID-19.Measurements: Following review of titles, abstracts and full text, we included 52 studies that contained 118,373 participants with COVID-19. Risk of bias was assessed using the Quality in Prognostic studies tool. Our primary outcome was mortality, secondary outcomes included delirium, intensive care unit admission, need for ventilation and discharge location. Where appropriate, random-effects meta-analysis was used to pool adjusted and unadjusted effect measures by frailty instrument.Results: The Clinical Frailty Scale (CFS) was the most used frailty instrument. Mortality was reported in 37 studies. After confounder adjustment, frailty identified using the CFS was significantly associated with mortality in COVID-19 positive patients (odds ratio 1.79, 95% confidence interval [CI] 1.49-2.14; hazard ratio 1.87, 95% CI 1.33-2.61). On an unadjusted basis, frailty identified using the CFS was significantly associated with increased odds of delirium and reduced odds of intensive care unit admission. Results were generally consistent using other frailty instruments. Patient-reported, cost and experience outcomes were rarely reported. Conclusion:Frailty is associated with a substantial increase in mortality risk in COVID-19 patients, even after adjustment. Delirium risk is also increased. Frailty assessment may help to guide prognosis and individualized care

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“…The details regarding excluded articles can be seen in Appendix A. As a result, 9 studies were included in this meta-analysis [21][22][23][24][25][26][27][28][29] with an overall of 19,660 Covid-19 patients with diabetes mellitus (Fig. 1).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Pre-admission glucagon-like peptide-1 receptor agonist (GLP-1RA) and mortality from coronavirus disease 2019 (Covid-19): A systematic review, meta-analysis, and meta-regression

Hariyanto

Intan

Hananto

et al. 2021

Diabetes Research and Clinical Practice

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Aims GLP-1RA has many beneficial properties, including anti-inflammatory, anti-obesogenic, pulmonary protective effects as well as beneficial impact on gut microbiome. However, the evidence regarding the benefit of GLP-1RA in Covid-19 patients with diabetes is still unclear. This study sought to analyze the benefit of pre-admission use of GLP-1RA in altering the mortality outcomes of coronavirus disease 2019 (Covid-19) patients with diabetes mellitus. Methods Using specific keywords, we comprehensively searched the potential articles on PubMed, Europe PMC, and medRxiv database until June 12 th , 2021. All published studies on Covid-19 and GLP-1RA were retrieved. Statistical analysis was conducted using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software. Results A total of 9 studies with 19,660 diabetes mellitus patients who were infected by SARS-CoV-2 were included in the meta-analysis. Our data suggested that pre-admission use of GLP-1RA was associated with reduction in mortality rate from Covid-19 in patients with diabetes mellitus (OR 0.53; 95%CI: 0.43 – 0.66, p <0.00001, I 2 = 0%, random-effect modelling). Further analysis showed that the associations were not influenced by age ( p =0.213), gender (p=0.421), hypertension (p=0.131), cardiovascular disease (p=0.293), nor the use of metformin (p=0.189) and insulin (p=0.117). Conclusions Our study suggests that pre-admission use of GLP-1RA may offer beneficial effects on Covid-19 mortality in patients with diabetes mellitus. However, more randomized clinical trials are required to confirm this conclusion.

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Adverse outcomes in COVID-19 and diabetes: a retrospective cohort study from three London teaching hospitals

Cited by 56 publications

References 32 publications

Managing diabetes in diabetic patients with COVID: where do we start from?

Managing diabetes in diabetic patients with COVID: where do we start from?

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

Pre-admission glucagon-like peptide-1 receptor agonist (GLP-1RA) and mortality from coronavirus disease 2019 (Covid-19): A systematic review, meta-analysis, and meta-regression

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