Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis

Abstract

Background: Many studies on COVID-19 have reported diabetes to be associated with severe disease and mortality, however, the data is conflicting. The objectives of this meta-analysis were to explore the relationship between diabetes and COVID-19 mortality and severity, and to determine the prevalence of diabetes in patients with COVID-19. Methods: We searched the PubMed for case-control studies in English, published between Jan 1 and Apr 22, 2020, that had data on diabetes in patients with COVID-19. The frequency of diabetes was compared between patients with and without the composite endpoint of mortality or severity. Random effects model was used with odds ratio as the effect size. We also determined the pooled prevalence of diabetes in patients with COVID-19. Heterogeneity and publication bias were taken care by meta-regression, subgroup analyses, and trim and fill methods. Results: We included 33 studies (16,003 patients) and found diabetes to be significantly associated with mortality of COVID-19 with a pooled odds ratio of 1.90 (95% CI: 1.37e2.64; p < 0.01). Diabetes was also associated with severe COVID-19 with a pooled odds ratio of 2.75 (95% CI: 2.09e3.62; p < 0.01). The combined corrected pooled odds ratio of mortality or severity was 2.16 (95% CI: 1.74e2.68; p < 0.01). The pooled prevalence of diabetes in patients with COVID-19 was 9.8% (95% CI: 8.7%e10.9%) (after adjusting for heterogeneity). Conclusions: Diabetes in patients with COVID-19 is associated with a twofold increase in mortality as well as severity of COVID-19, as compared to non-diabetics. Further studies on the pathogenic mechanisms and therapeutic implications need to be done.

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

“…Also, CLD patients with diabetes had more acute liver injury [OR 2.1 (95CI = 1.1-3.73),p = 0.01]. Higher incidence of ALI has also been reported in diabetics without liver disease [23]. In the present study, MAFLD was the commonest cause for CLD without cirrhosis, whereas hepatitis B was common in cirrhotics [24].…”

Factors Associated with COVID-Related Mortality: The Case of Texas

“…These ndings are consistent with previous studies that reported greater mortality in patients with COVID-19 and diabetes [22]. For example, Kumar and colleagues reported a two-fold increase in mortality for diabetes patients, compared to non-diabetics [23]. The most signi cant increase in mortality, however, was in regard to self-reported fair/poor health, as de ned by the CDC Heathy Days measure [24].This is consistent with prior studies that have shown a correlation between COVID-19 outcomes and lower healthrelated quality of life [25], as well as poorer outcomes for patients who have comorbid hypertension, diabetes, cardiovascular disease and respiratory diseases [26].…”

Diabetes, obesity and COVID‐19: A complex interplay

“…Pooled analyses from these early studies have indicated a prevalence rate of diabetes between 9.8% to 11.5%, after adjusting for heterogeneity 15,16 . Likewise, meta‐analyses of early studies have suggested a 2‐ to 3‐fold increase in the risk of severe forms of COVID‐19 including critical admissions, and mortality in diabetes 15,17–19 . Diabetes may also predispose to co‐morbidity in the context of COVID‐19 infection, as has been reported for acute stroke 20 .…”