Diabetes mellitus increases the risk of hospital mortality in patients with Covid-19

Abstract

Background: The mortality rate associated with Covid-19 varies considerably among studies and determinants of this variability are not well characterized. Methods: A systematic review of peer-reviewed literature published through March 31, 2020 was performed to estimate the mortality rate among hospitalized patients in China with a confirmed diagnosis of Covid-19. Hospital mortality rates were estimated using an inverse variance-weighted random-effects meta-analysis model. Funnel plot symmetry was evaluated for small-study effects, a one-study removed sensitivity analysis assessed the influence of individual studies on the pooled mortality rate, and metaregression assessed the association of potential confounding variables with mortality rates. Results: The review included 16 observational studies involving 1832 hospitalized patients with a diagnosis of Covid-19. The surveillance period among studies ranged from December 16, 2019 to February 23, 2020. The median patient age was 53 years and 53% were males. A total of 38.5% of patients presented with at least 1 comorbidity, most commonly hypertension (24.0%), cardiac disease (15.1%), and diabetes mellitus (14.4%). Fever and cough, reported in 84.8% and 61.7% of patients respectively, were the most common patient symptoms. The pooled mortality rate was 9.9% (95% confidence interval 6.1% to 14.5%). Funnel plot asymmetry was not observed and the meta-analysis results were not substantially influenced by any single study since the pooled mortality rate ranged from 8.9% to 11.1% following iterative removal of one study at a time. Substantial heterogeneity in the mortality rate was identified among studies ( I 2 = 87%; P < .001). In a metaregression that included demographics, patient risk factors, and presenting symptoms, only a higher prevalence of diabetes mellitus was associated with a higher mortality rate ( P = .03). Conclusions: In a meta-analysis of hospitalized patients in China with a diagnosis of Covid-19, the mortality rate was 9.9% and a higher diabetes mellitus prevalence was independently associated with a worse prognosis. The independent influence of diabetes mellitus with Covid-19 mortality should be viewed as hypothesis-generating and warrants further study.

Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis

“…The population particularly affected by the COVID-19 hyperglycemia are older people as demonstrated by Xue et al [ 51 ] as it seems that this population has an increased risk of hyperglycemia occurrence overall. Interestingly, a meta-analysis by Miller et al [ 52 ] revealed that the prevalence of diabetes increases the mortality, while comorbidities do not affect the overall number of deaths. The same findings have been observed by Shang [ 53 ], whose team goes as far as to conclude that not only the diabetic patients shall avoid exposure to COVID-19 but also when treated they should be monitored more closely with special attention to improve prognosis.…”

Why Is COVID-19 More Severe in Patients With Diabetes? The Role of Angiotensin-Converting Enzyme 2, Endothelial Dysfunction and the Immunoinflammatory System

“…The outcome of these studies have identified a number of key factors that associate with critical/fatal events, most notably: gender (male, compound odds ratio (OR): 1.76), black, Asian or mixed ethnicity, BAME (OR: 1.9); age (OR: 6.06), smoking (OR: 2.04), cardiovascular disease (OR: 5.19), respiratory disease (OR: 5.15), malignancy (OR: 1.6) ( 2 ), hypertension (OR: 3.36) ( 7 ), severe mental illness (OR: 2.27) ( 8 ), and obesity (OR: 5.70) ( 9 ). Diabetes has been identified as a comorbidity associated with COVID-19 severity, with meta-analyses indicating that pre-existing diabetes is associated with a greater risk of severe COVID-19 and death ( Table 1 ) with OR from 1.9 to 2.68 ( 4 , 27 , 32 , 40 , 55 , 59 , 64 ). Studies of COVID-19 patients in England found that the hazard risk for mortality was greater for patients with type 1 diabetes mellitus (T1DM: OR 2.23) than those with type 2 diabetes mellitus (T2DM: OR 1.61) ( 65 ).…”

A novel multi-omics-based identification of symptoms, comorbid conditions, and possible long-term complications in COVID-19

“…In this analysis too, the viral infection is ranked one. The common comorbid conditions such as autoimmune disease (Rank-2) [50], vascular disease (Rank-4) [71], kidney disease (Rank-5) [56, 57], neurodegenerative disease (Rank-6) [72], bone inflammation disease (Rank-7) [73], myocardial disorder (Rank-7) [74], mood disorder (Rank-7) [34], breast cancer (Rank-10) [75], liver disease (Rank-10) [58], gynaecologic cancers (Rank-11) [76], asthma (Rank-12) [77], liver cancer (Rank-13) [78], musculoskeletal abnormality (Rank-14) [63], hematologic cancer (Rank-15) [79], retinal degeneration (Rank-15) [80], sepsis / septicaemia / septic shock (Rank-15) [60, 81], diabetes (Rank-16) [82], other cardiovascular diseases (Rank-17) [71, 74], viral encephalitis (Rank-17) [83], other cognitive disorder (Rank-18) [24], immunodeficiency (Rank-19) [84], brain disease (Rank-19) [85], COPD (Rank-19) [86], gastric / colon cancer (Rank-20) [87], autism (Rank-21) [88, 89], anemia (Rank-21) [90], bone development and degenerative disease (Rank-20) [91], dyslipidaemia (Rank-22) [92, 93], and ataxia (Rank-23) [94] etc. are among the top 25 child disease categories at a cut off score of 4 ( Fig-2B ).…”

“…According to rank (with a cut off score 4), the enriched known or reported comorbid conditions or long-term complications are lupus erythematosus (Rank-1) [100], depressive disorder / mental depression (Rank-2) [30, 101], hepatitis C (Rank-3) [102], breast cancer (Rank-4) [75], arthritis (Rank-5) [103], asthma (Rank-6) [10, 77], liver cancer (Rank-6) [78], tuberculosis (Rank-7) [104, 105], diabetes (Rank-8) [82], myocardial infarction (Rank-9) [35, 106], macular degeneration (Rank-9) [80], chronic kidney disease (Rank-9) [56, 57], arteriosclerosis (Rank-10) [107], ulcerative colitis (Rank-10) [108], liver cirrhosis (Rank-11) [12, 109], sepsis / septicaemia /septic shock (Rank-11) [60, 81], other autoimmune diseases (Rank-12) [49, 50], cerebrovascular accident / stroke (Rank-13) [110], congenital anemia (Rank-13) [111], COPD (Rank-13) [86], multiple myeloma (Rank-14) [112], hypertensive disease (Rank-14) [9, 113], dyslipidemia (Rank-15) [93], metabolic syndrome X (Rank-15) [51, 114], osteoporosis (Rank-16) [91], prostate cancer (Rank-17) [115], psoriasis (Rank-17) [116], leukemia (Rank-18) [117, 118], long QT syndrome (Rank-18) [119], dementia (Rank-18) [120], schizophrenia (Rank-18) [121], intellectual disability (Rank-18) [122, 123], diabetic kidney disease/ diabetic nephropathy (Rank-18) [124]etc.…”