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Meta-Analysis
. 2021 Aug;58(8):1101-1110.
doi: 10.1007/s00592-021-01701-1. Epub 2021 Mar 20.

Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis

Halla Kaminska  1 , Lukasz Szarpak  2   3 , Dariusz Kosior  4   5 , Wojciech Wieczorek  6 , Agnieszka Szarpak  7 , Mahdi Al-Jeabory  8 , Wladyslaw Gawel  9 , Aleksandra Gasecka  10   11   12 , Milosz J Jaguszewski  13 , Przemyslawa Jarosz-Chobot  1
Affiliations
Meta-Analysis

Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis

Halla Kaminska et al. Acta Diabetol. 2021 Aug.

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020, placing the heavy burden on the health systems all over the world. The population that particularly has been affected by the pandemic is the group of patients suffering from diabetes mellitus. Having taken the public health in considerations, we have decided to perform a systematic review and meta-analysis of diabetes mellitus on in-hospital mortality in patients with COVID-19.

Methods: A systematic literature review (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane) including all published clinical trials or observational studies published till December 10, 2020, was performed using following terms "diabetes mellitus" OR "diabetes" OR "DM" AND "survival" OR "mortality" AND "SARS-CoV-2" OR "COVID-19".

Results: Nineteen studies were included out of the 7327 initially identified studies. Mortality of DM patients vs non-DM patients was 21.3 versus 6.1%, respectively (OR = 2.39; 95%CI: 1.65, 3.64; P < 0.001), while severe disease in DM and non-DM group varied and amounted to 34.8% versus 22.8% (OR = 1.43; 95%CI: 0.82, 2.50; P = 0.20). In the DM group, the complications were observed far more often when compared with non-DM group, both in acute respiratory distress (31.4 vs. 17.2%; OR = 2.38; 95%CI:1.80, 3.13; P < 0.001), acute cardiac injury (22.0% vs. 12.8%; OR = 2.59; 95%CI: 1.81, 3.73; P < 0.001), and acute kidney injury (19.1 vs. 10.2%; OR = 1.97; 95%CI: 1.36, 2.85; P < 0.001).

Conclusions: Based on the findings, we shall conclude that diabetes is an independent risk factor of the severity of COVID-19 in-hospital settings; therefore, patients with diabetes shall aim to reduce the exposure to the potential infection of COVID-19.

Keywords: COVID-19; Diabetes mellitus; Hospitalization; Meta-analysis; Mortality; SARS-CoV-2; Systematic review.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram showing stages of database searching and study selection as per PRISMA guidelines
Fig. 2
Fig. 2
Forest plot of In-hospital mortality in DM versus non-DM group. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. DM Diabetes mellitus; CI Confidence interval; M–H Mantel–Haenszel model
Fig. 3
Fig. 3
Forest plot of clinical conditions in DM versus non-DM group. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. DM Diabetes mellitus; CI Confidence interval; M–H Mantel–Haenszel model
Fig. 4
Fig. 4
Forest plot of adverse events in DM versus non-DM group. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. DM Diabetes mellitus; CI Confidence interval; M–H Mantel–Haenszel model
Fig. 5
Fig. 5
Forest plot of length of hospital stay in DM versus non-DM group. The center of each square represents the weighted mean differences for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. DM Diabetes mellitus; CI Confidence interval; M–H Mantel–Haenszel model
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