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Meta-Analysis
. 2021 Jun;20(2):305-314.
doi: 10.1007/s42000-020-00246-2. Epub 2020 Oct 29.

Diabetes is associated with increased risk for in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis comprising 18,506 patients

Leonidas Palaiodimos  1   2   3 , Natalia Chamorro-Pareja  4   5 , Dimitrios Karamanis  6 , Weijia Li  4   5 , Phaedon D Zavras  4   5 , Kai Ming Chang  4   5   7 , Priyanka Mathias  4   5   8 , Damianos G Kokkinidis  4   5
Affiliations
Meta-Analysis

Diabetes is associated with increased risk for in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis comprising 18,506 patients

Leonidas Palaiodimos et al. Hormones (Athens). 2021 Jun.

Abstract

Purpose: Infectious diseases are more frequent and can be associated with worse outcomes in patients with diabetes. The aim of this study was to systematically review and conduct a meta-analysis of the available observational studies reporting the effect of diabetes on mortality among hospitalized patients with COVID-19.

Methods: The Medline, Embase, Google Scholar, and medRxiv databases were reviewed for identification of eligible studies. A random effects model meta-analysis was used, and I2 was utilized to assess the heterogeneity. In-hospital mortality was defined as the endpoint. Sensitivity, subgroup, and meta-regression analyses were performed.

Results: A total of 18,506 patients were included in this meta-analysis (3713 diabetics and 14,793 non-diabetics). Patients with diabetes were associated with a higher risk of death compared with patients without diabetes (OR 1.65; 95% CI 1.35-1.96; I2 77.4%). The heterogeneity was high. A study-level meta-regression analysis was performed for all the important covariates, and no significant interactions were found between the covariates and the outcome of mortality.

Conclusion: This meta-analysis shows that that the likelihood of death seems to be higher in diabetic patients hospitalized with COVID-19 compared with non-diabetic patients. Further studies are needed to assess whether this association is independent or not, as well as to investigate the role of adequate glycemic control prior to infection with COVID-19.

Keywords: COVID-19; Diabetes; Meta-analysis; Mortality; Risk factor; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA 2009 flow diagram
Fig. 2
Fig. 2
Risk of bias assessment based on the Quality in Prognosis Studies (QUIPS) tool
Fig. 3
Fig. 3
Overall analysis: diabetes vs. no diabetes for in-hospital mortality
Fig. 4
Fig. 4
Sensitivity and subgroup analyses based on the region of the study origin and the mean/median age of the study population: diabetes vs. no diabetes for in-hospital mortality
Fig. 5
Fig. 5
Funnel plot for assessment of publication bias. Funnel plot is asymmetric among smaller studies suggesting possible publication bias. However, Egger’s test was non-significant, thus, it was not suggestive of publication bias (p = 0.255)
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