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Meta-Analysis
. 2021 Jul 22:12:696087.
doi: 10.3389/fendo.2021.696087. eCollection 2021.

Insulin Treatment May Increase Adverse Outcomes in Patients With COVID-19 and Diabetes: A Systematic Review and Meta-Analysis

Yan Yang  1 , Zixin Cai  1 , Jingjing Zhang  1
Affiliations
Meta-Analysis

Insulin Treatment May Increase Adverse Outcomes in Patients With COVID-19 and Diabetes: A Systematic Review and Meta-Analysis

Yan Yang et al. Front Endocrinol (Lausanne). .

Abstract

Background and objective: Recently, insulin treatment has been found to be associated with increased mortality and other adverse outcomes in patients with coronavirus disease 2019 (COVID-19) and diabetes, but the results remain unclear and controversial, therefore, we conducted this meta-analysis.

Methods: Four databases, namely, PubMed, Web of Science, EMBASE and the Cochrane Library, were used to identify all studies concerning insulin treatment and the adverse effects of COVID-19, including mortality, incidence of severe/critical complications, in-hospital admission and hospitalization time. To assess publication bias, funnel plots, Begg's tests and Egger's tests were used. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the effect of insulin therapy on mortality, severe/critical complications and in-hospital admission. The association between insulin treatment and hospitalization time was calculated by the standardized mean difference (SMD) with 95% CIs.

Results: Eighteen articles, involving a total of 12277 patients with COVID-19 and diabetes were included. Insulin treatment was significantly associated with an increased risk of mortality (OR=2.10; 95% CI, 1.51-2.93) and incidence of severe/critical COVID-19 complications (OR=2.56; 95% CI, 1.18-5.55). Moreover, insulin therapy may increase in-hospital admission in patients with COVID-19 and diabetes (OR=1.31; 95% CI, 1.06-1.61). However, there was no significant difference in the hospitalization time according to insulin treatment (SMD=0.21 95% CI, -0.02-0.45).

Conclusions: Insulin treatment may increase mortality and severe/critical complications in patients with COVID-19 and diabetes, but more large-scale studies are needed to confirm and explore the exact mechanism.

Keywords: COVID-19; adverse outcomes; complications; diabetes; insulin treatment; mortality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Forest plots of OR for the association between the insulin treatment and the mortality of COVID-19.
Figure 3
Figure 3
Funnel plot of the association between the insulin treatment and the mortality (A), complications (B), and the in-hospital admission (C) of COVID-19.
Figure 4
Figure 4
Sensitivity analysis for the effect insulin treatment on the mortality (A), complications (B), and the in-hospital admission (C) of COVID-19.
Figure 5
Figure 5
Forest plots of OR for the association between the insulin treatment and the complications of COVID-19.
Figure 6
Figure 6
Forest plots of OR for the overall result (A) and subgroup analysis based on type of diabetes (B) of the association between the insulin treatment and the in-hospital admission of COVID-19.
Figure 7
Figure 7
Forest plots of SMD for the association between the insulin treatment and the hospitalization time of COVID-19.
See this image and copyright information in PMC

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