Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis

Shang, Luxiang; Shao, Mengjiao; Guo, Qilong; Shi, Jia; Zhao, Yang; Xiaokereti, Jiasuoer; Tang, Baopeng

doi:10.1016/j.arcmed.2020.07.005

Cited by 70 publications

(90 citation statements)

References 91 publications

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“…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.…”

Section: Discussionsupporting

confidence: 80%

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

et al. 2021

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Background The novel coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020, placing the heavy burden on the health systems all over the world. The population that particularly has been affected by the pandemic is the group of patients suffering from diabetes mellitus. Having taken the public health in considerations, we have decided to perform a systematic review and meta-analysis of diabetes mellitus on in-hospital mortality in patients with COVID-19. Methods A systematic literature review (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane) including all published clinical trials or observational studies published till December 10, 2020, was performed using following terms “diabetes mellitus” OR “diabetes” OR “DM” AND “survival” OR “mortality” AND “SARS-CoV-2” OR “COVID-19”. Results Nineteen studies were included out of the 7327 initially identified studies. Mortality of DM patients vs non-DM patients was 21.3 versus 6.1%, respectively (OR = 2.39; 95%CI: 1.65, 3.64; P < 0.001), while severe disease in DM and non-DM group varied and amounted to 34.8% versus 22.8% (OR = 1.43; 95%CI: 0.82, 2.50; P = 0.20). In the DM group, the complications were observed far more often when compared with non-DM group, both in acute respiratory distress (31.4 vs. 17.2%; OR = 2.38; 95%CI:1.80, 3.13; P < 0.001), acute cardiac injury (22.0% vs. 12.8%; OR = 2.59; 95%CI: 1.81, 3.73; P < 0.001), and acute kidney injury (19.1 vs. 10.2%; OR = 1.97; 95%CI: 1.36, 2.85; P < 0.001). Conclusions Based on the findings, we shall conclude that diabetes is an independent risk factor of the severity of COVID-19 in-hospital settings; therefore, patients with diabetes shall aim to reduce the exposure to the potential infection of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00592-021-01701-1.

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Section: Discussionsupporting

confidence: 80%

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

et al. 2021

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“…As we have shown in this study, other publications have reported that chronic diseases such as diabetes, asthma, hypertension, chronic kid-ney disease, air pollution, and obesity are associated with a high risk of infection and death in COVID-19 patients [10][11][12][13][14][15][29][30][31]. These conditions occur and tend to converge more frequently in older people, but in the middle-aged population (aged 40-55 years) many other possible explanations emerge as to why they are also at high risk of death, when compared with younger persons aged < 40 years, even when they may be free of prevailing chronic diseases.…”

Section: Discussionsupporting

confidence: 73%

Ethnicity and other COVID-19 death risk factors in Mexico

et al. 2020

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IntroductionPatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop coronavirus disease 2019 (COVID-19). Risk factors associated with death vary among countries with different ethnic backgrounds. We aimed to describe the factors associated with death in Mexicans with confirmed COVID-19.Material and methodsWe analysed the Mexican Ministry of Health’s official database on people tested for SARS-CoV-2 infection by real-time reverse transcriptase–polymerase chain reaction (rtRT-PCR) of nasopharyngeal fluids. Bivariate analyses were performed to select characteristics potentially associated with death, to integrate a Cox-proportional hazards model.ResultsAs of May 18, 2020, a total of 177,133 persons (90,586 men and 86,551 women) in Mexico received rtRT-PCR testing for SARS-CoV-2. There were 5332 deaths among the 51,633 rtRT-PCR-confirmed cases (10.33%, 95% CI: 10.07–10.59%). The median time (interquartile range, IQR) from symptoms onset to death was nine days (5–13 days), and from hospital admission to death 4 days (2–8 days). The analysis by age groups revealed that the significant risk of death started gradually at the age of 40 years. Independent death risk factors were obesity, hypertension, male sex, indigenous ethnicity, diabetes, chronic kidney disease, immunosuppression, chronic obstructive pulmonary disease, age > 40 years, and the need for invasive mechanical ventilation (IMV). Only 1959 (3.8%) cases received IVM, of whom 1893 were admitted to the intensive care unit (96.6% of those who received IMV).ConclusionsIn Mexico, highly prevalent chronic diseases are risk factors for death among persons with COVID-19. Indigenous ethnicity is a poorly studied factor that needs more investigation.

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“…For instance, the prevalence was reported 68.3% in Saudi Arabia [4] , 33.8% in New York [11] , and 20.9% in Greece [19] . In a meta-analysis, the prevalence of diabetes was 10% in China [20] , and 26.5% in studies outside of China [21] . Likewise, the prevalence of diabetes ranged from 13.0% to 40.2% in multicenter studies reported in similar time frames to our study [10] , [11] , [22] , [23] , [24] .…”

Section: Discussionmentioning

confidence: 98%

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

Satman

Demirci

Haymana

et al. 2021

Diabetes Research and Clinical Practice

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Aims Type 2 diabetes mellitus (T2DM) is a risk factor for severe COVID-19. Our aim was to compare the clinical outcomes of patients with and without T2DM during the first hit of COVID-19 in Istanbul Methods A retrospective population-based study was conducted including all consecutive adult symptomatic COVID-19 cases. Patients were confirmed with rt-PCR; treated and monitored in accordance with standard protocols. The primary endpoints were hospitalization and 30-day mortality Results Of the 93,571 patients, 22.6% had T2DM, with older age and higher BMI. Propensity Score matched evaluation resulted in significantly higher rates of hospitalization (1.5-fold), 30-day mortality (1.6-fold), and pneumonia (1.4-fold). They revealed more severe laboratory deviations, comorbidities, and frequent drug usage than the Non-DM group. In T2DM age, pneumonia, hypertension, obesity, and insulin-based therapies were associated with an increased likelihood of hospitalization; whereas age, male gender, lymphopenia, obesity, and insulin treatment were considerably associated with higher odds of death Conclusions COVID-19 patients with T2DM had worse clinical outcomes with higher hospitalization and 30-day mortality rates than those without diabetes. Compared to most territories of the world, COVID-19 mortality was much lower in Istanbul, which may be associated with accessible healthcare provision and the younger structure of the population

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Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis

Cited by 70 publications

References 91 publications

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

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

Ethnicity and other COVID-19 death risk factors in Mexico

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

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