Impact of diabetes on COVID‐19 mortality and hospital outcomes from a global perspective: An umbrella systematic review and meta‐analysis

Abstract

Introduction To date, COVID‐19 has claimed 4.9 million lives. Diabetes has been identified as an independent risk factor of serious outcomes in people with COVID‐19 infection. Whether that holds true across world regions uniformly has not been previously assessed. Methods This study offers the first umbrella systematic review and meta‐analysis to analyse the collective and geographically stratified mortality, ICU admission, ventilation requirement, illness severity and discharge rate amongst patients with diabetes. Five databases (EMBASE, MEDLINE, CAB Abstracts, PsychInfo and Web of Science) and 3 additional sources (SSRN's eLibrary, Research Square and MedRxiv) were searched from inception to 30 August 2021. Prospective and retrospective cohort studies, reporting the association between diabetes and one or more COVID‐19 hospitalization outcomes, were included. This meta‐analysis was registered on PROSPERO, CRD42021278579. Abbreviated MeSH terms used for search were as follows: (Diabetes) AND (2019 Novel Coronavirus Disease), adapted per database requirements. Exclusion criteria exclusion criteria were as follows: (1) none of the primary or secondary outcomes of meta‐analysis reported, (2) no confirmed COVID‐19 infection (laboratory or clinical) and (3) no unexposed population (solely patients with diabetes included). Quality of the included studies were assessed using the Newcastle‐Ottawa Scale (NOS) whilst quality of evidence by the GRADE framework. Studies that were clinically homogeneous were pooled. Summative data and heterogeneity were generated by the Cochrane platform RevMan (V. 5.4). Results Overall, 158 observational studies were included, with a total of 270,212 of participants, median age 59 [53–65 IQR] of who 56.5% were male. A total of 22 studies originated from EU, 90 from Far East, 16 from Middle East and 30 from America. Data were synthesized with mixed heterogeneity across outcomes. Pooled results highlighted those patients with diabetes were at a higher risk of COVID‐19‐related mortality, OR 1.87 [95%CI 1.61, 2.17]. ICU admissions increased across all studies for patients with diabetes, OR 1.59 [95%CI 1.15, 2.18], a result that was mainly skewed by Far East‐originating studies, OR 1.94 [95%CI 1.51, 2.49]. Ventilation requirements were also increased amongst patients with diabetes worldwide, OR 1.44 [95%CI 1.20, 1.73] as well as their presentation with severe or critical condition, OR 2.88 [95%CI 2.29, 3.63]. HbA1C levels under <70 mmol and metformin use constituted protective factors in view of COVID‐19 mortality, whilst the inverse was true for concurrent insulin use. Conclusions Whilst diabetes constitutes a poor prognosticator for various COVID‐19 infection outcomes, variability across world regions is significant and may skew overall trends.

Association between Fibrinogen-to-Albumin Ratio and Prognosis of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Third, given the significant variations in disease severity and mortality with geographical locations and different phases of the pandemic [ 5 ], the inclusion of predominantly Turkish studies may not justify the extrapolation of our results to other countries and ethnic groups. Fourth, although comorbidities have been found to contribute to mortality and severity in patients diagnosed with COVID-19 [ 56 , 57 ], the lack of relevant information precluded a subgroup analysis of their potential impacts on our study outcomes. Fifth, of the 10 included studies, only four provided relevant information about the equipment and procedures for fibrinogen measurement [ 24 , 33 , 35 , 37 ].…”

The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)

“…A recent meta-analysis, including 158 observational studies with a total of 270,212 participants, of whom 57,801 had diabetes, reported that people with diabetes were at higher risk of COVID-19-related mortality with an OR 1.87 (95% CI 1.61–2.17) and higher risk of ICU admission (1.59 [95% CI 1.15–2.18]) and ventilation requirements (1.44 [95% CI 1.20–1.73]) in comparison to subjects without diabetes [ 11 ]. In addition, cardiovascular disease is common comorbidity observed in patients with COVID-19, associated with increased severity and mortality [ 22 ].…”

“…As well, pre-existing diabetes mellitus has been considered a risk factor for increased COVID-19 severity and worse outcomes, including higher mortality, irrespective of age and comorbidity status [ 7 ]. The estimates of diabetes prevalence in those who have died of COVID-19 range from 20 to 30% [ 10 , 11 ]. A recent meta-analysis showed that people with diabetes were at higher risk of COVID-19-related mortality in comparison to people without diabetes [ 11 ].…”

“…The estimates of diabetes prevalence in those who have died of COVID-19 range from 20 to 30% [ 10 , 11 ]. A recent meta-analysis showed that people with diabetes were at higher risk of COVID-19-related mortality in comparison to people without diabetes [ 11 ]. In addition, diabetes is associated with more than double the risk for ICU admission and more than triple the risk of death compared to people without diabetes [ 12 ].…”

Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review

“…The COVID-19 outbreak has recently changed the daily routine of children and adolescents, with a tendency for a sedentary lifestyle and altered dietary habits. Adult patients with T1DM have been included in the high-risk group for COVID-19 infection with high mortality and morbidity rate and priority was given once vaccination was available ( 54 ). As regards children with T1DM, in the first year of pandemics evidence was weak.…”