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Meta-Analysis
. 2020 Jul 24;30(8):1236-1248.
doi: 10.1016/j.numecd.2020.05.014. Epub 2020 May 29.

Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: A meta-analysis of observational studies

Alessandro Mantovani  1 , Christopher D Byrne  2 , Ming-Hua Zheng  3 , Giovanni Targher  4
Affiliations
Meta-Analysis

Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: A meta-analysis of observational studies

Alessandro Mantovani et al. Nutr Metab Cardiovasc Dis. .

Abstract

Aims: To estimate the prevalence of established diabetes and its association with the clinical severity and in-hospital mortality associated with COVID-19.

Data synthesis: We systematically searched PubMed, Scopus and Web of Science, from 1st January 2020 to 15th May 2020, for observational studies of patients admitted to hospital with COVID-19. Meta-analysis was performed using random-effects modeling. A total of 83 eligible studies with 78,874 hospitalized patients with laboratory-confirmed COVID-19 were included. The pooled prevalence of established diabetes was 14.34% (95% CI 12.62-16.06%). However, the prevalence of diabetes was higher in non-Asian vs. Asian countries (23.34% [95% CI 16.40-30.28] vs. 11.06% [95% CI 9.73-12.39]), and in patients aged ≥60 years vs. those aged <60 years (23.30% [95% CI 19.65-26.94] vs. 8.79% [95% CI 7.56-10.02]). Pre-existing diabetes was associated with an approximate twofold higher risk of having severe/critical COVID-19 illness (n = 22 studies; random-effects odds ratio 2.10, 95% CI 1.71-2.57; I2 = 41.5%) and ~threefold increased risk of in-hospital mortality (n = 15 studies; random-effects odds ratio 2.68, 95% CI 2.09-3.44; I2 = 46.7%). Funnel plots and Egger's tests did not reveal any significant publication bias.

Conclusions: Pre-existing diabetes is significantly associated with greater risk of severe/critical illness and in-hospital mortality in patients admitted to hospital with COVID-19.

Keywords: COVID-19; Coronavirus disease 2019; Diabetes; Meta-analysis; SARS-CoV-2.

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Figures

Figure 1
Figure 1
The PRISMA flow diagram of the meta-analysis.
Figure 2
Figure 2
Forest plot and pooled prevalence of established diabetes among patients with laboratory-confirmed COVID-19, stratified by age (n = 83 studies included).
Figure 3
Figure 3
Forest plot and pooled prevalence of established diabetes among patients with laboratory-confirmed COVID-19, stratified by study country (n = 83 studies included).
Figure 4
Figure 4
Forest plot and pooled risk of having severe/critical COVID-19 among patients with and without established diabetes (n = 22 studies included). Note: ∗in the study of Targher et al. [96] the odds ratio for severe/critical COVID-19 was adjusted for age, sex, smoking history, obesity and hypertension.
Figure 5
Figure 5
Forest plot and pooled risk of COVID-19-related in-hospital mortality among patients with and without established diabetes (n = 15 studies included). Note: ∗in a subsequent study conducted on the same database (Crit Care. 2020 Apr 28; 24:179), Deng G et al. reported that the fatality rate of COVID-19 patients with diabetes was higher than that of patients without diabetes.
Figure 6
Figure 6
Univariable linear meta-regression analyses. A meta-analysis of the association of either age (panels A and C) or sex (panels B and D) with the diabetes-related risk of COVID-19 severity or in-hospital mortality.
See this image and copyright information in PMC

Comment in

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