Diabetes in COVID‐19 pandemic‐prevalence, patient characteristics and adverse outcomes

Abstract

Background: Current literature on COVID-19 pandemic has identified diabetes as a common comorbidity in patients affected. However, the evidence that diabetes increases the risk of infection, effect of diabetes on outcomes and characteristics of patients at risk is not clear.Objectives:To explore the prevalence of diabetes in COVID-19 pandemic, effect of diabetes on clinical outcomes and to characterise the patients with diabetes affected by COVID-19.Methods:A literature review of articles published in English language and reported outcomes on prevalence and effect of diabetes on outcomes and patients' characteristics. Results:The prevalence of diabetes in COVID-19 patients appears similar to that in the general population. The evidence of diabetes increasing the risk of severe infection and adverse outcomes is substantial. The progression of the disease into acute respiratory distress syndrome, the requirement for intensive care admission or mechanical ventilation and mortality all have been increased by the presence of diabetes. Patients with diabetes at risk of COVID-19 appear to be obese, of older age, have uncontrolled glycaemia and have coexisting comorbidities especially cardiovascular disease and hypertension. Tight glycaemic control on admission to hospital using insulin infusion has shown some beneficial effects; however, the role of hypoglycaemic medications in the management of these patients is not yet clear. Conclusion:High risk group should be identified and prioritised in future vaccinationprogrammes. Future research is required to optimise management of patients with diabetes and develop new ways to manage them via technological developments such as telecare. Keypoints• Diabetes is a common comorbidity in patients with COVID-19.• Diabetes is associated with severe illness and worse outcomes.• Uncontrolled diabetes and obesity appear to be the major characteristics of patients at risk.• Frailty may be a confounding factor that increases the risk of adverse outcomes.• Future research is required to optimise the management of patients with diabetes and COVID-19. 1527 patients with COVID-19. A. Proportions of hypertension, CCVD and diabetes were 17.1%, 16.4% and 9.7%, respectively. B. Incidences of hypertension, CCVD and diabetes were twofold, threefold and twofold, respectively higher in ICU/severe cases compared with non-ICU/severe counterparts. C. Diabetes accounted for 11.7% of ICU/severe cases and 4.0% of non-ICU/severe cases, RR 2.21, 95% CI 0.88-5.57, P = .09 Guan WJ, et al Retrospective China 1099 patients with COVID-19. A. 81 (7.4%) of patients had diabetes. B. Primary composite end point of admission to ICU, mechanical ventilation or death occurred in 26.9% of patients with diabetes, only second to hypertension (35.8%). WU C, et al Retrospective China 201 patients with COVID-19. A. 41.8% of patients developed ARDS. B. Patients with compared with those without ARDS had comorbidities such as hypertension (27.4% vs 13.7%, difference 13.7%, 95% CI 1.3% to 26.1%) and diabetes (19.0% vs 5.1%, diff...

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