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. 2021 Dec;44(12):2790-2811.
doi: 10.2337/dc21-0930. Epub 2021 Oct 28.

Risks of and From SARS-CoV-2 Infection and COVID-19 in People With Diabetes: A Systematic Review of Reviews

Jamie Hartmann-Boyce  1 , Karen Rees  2 , James C Perring  3 , Sven A Kerneis  3 , Elizabeth M Morris  4 , Clare Goyder  4 , Afolarin A Otunla  3 , Olivia A James  3 , Nandana R Syam  3 , Samuel Seidu  5 , Kamlesh Khunti  5
Affiliations

Risks of and From SARS-CoV-2 Infection and COVID-19 in People With Diabetes: A Systematic Review of Reviews

Jamie Hartmann-Boyce et al. Diabetes Care. 2021 Dec.

Erratum in

Abstract

Background: This review was commissioned by the World Health Organization and presents a summary of the latest research evidence on the impact of coronavirus disease 2019 (COVID-19) on people with diabetes (PWD).

Purpose: To review the evidence regarding the extent to which PWD are at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and/or of suffering its complications, including associated mortality.

Data sources: We searched the Cochrane COVID-19 Study Register, Embase, MEDLINE, and LitCOVID on 3 December 2020.

Study selection: Systematic reviews synthesizing data on PWD exposed to SARS-CoV-2 infection, reporting data on confirmed SARS-CoV-2 infection, admission to hospital and/or to intensive care unit (ICU) with COVID-19, and death with COVID-19 were used.

Data extraction: One reviewer appraised and extracted data; data were checked by a second.

Data synthesis: Data from 112 systematic reviews were narratively synthesized and displayed using effect direction plots. Reviews provided consistent evidence that diabetes is a risk factor for severe disease and death from COVID-19. Fewer data were available on ICU admission, but where available, these data also signaled increased risk. Within PWD, higher blood glucose levels both prior to and during COVID-19 illness were associated with worse COVID-19 outcomes. Type 1 diabetes was associated with worse outcomes than type 2 diabetes. There were no appropriate data for discerning whether diabetes was a risk factor for acquiring SARS-CoV-2 infection.

Limitations: Due to the nature of the review questions, the majority of data contributing to included reviews come from retrospective observational studies. Reviews varied in the extent to which they assessed risk of bias.

Conclusions: There are no data on whether diabetes predisposes to infection with SARS-CoV-2. Data consistently show that diabetes increases risk of severe COVID-19. As both diabetes and worse COVID-19 outcomes are associated with socioeconomic disadvantage, their intersection warrants particular attention.

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Conflict of interest statement

Duality of Interest. K.K. reports payment to institution from Boehringer Ingelheim, AstraZeneca, Novartis, Novo Nordisk, Sanofi, Lilly, and Merck Sharp & Dohme and individual payment from Bayer, NAPP, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Berlin-Chemie AG/Menarini Group, Sanofi, Servier, and Boehringer Ingelheim. He is chair of the Ethnicity Subgroup of SAGE and member of Independent SAGE. No other potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
PRISMA diagram of study flow.
See this image and copyright information in PMC

References

    1. Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol 2020;8:813–822 - PMC - PubMed
    1. Hartmann-Boyce J, Morris E, Goyder C, et al. Diabetes and COVID-19: risks, management, and learnings from other national disasters. Diabetes Care 2020;43:1695–1703 - PubMed
    1. Centre for Evidence-Based Medicine . PROTOCOL rapid reviews of evidence for WHO scientific briefs on COVID-19 and selected noncommunicable diseases (NCDs), 2020. Accessed 10 May 2021. Available from https://www.cebm.net/covid-19/protocol-rapid-reviews-of-evidence-for-who...
    1. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017;358:j4008. - PMC - PubMed
    1. Mair M, Singhavi H, Pai A, et al. A meta-analysis of 67 studies with presenting symptoms and laboratory tests of COVID-19 patients. Laryngoscope 2020 - PubMed

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