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Meta-Analysis
. 2023 Jun;17(3):229-237.
doi: 10.1016/j.pcd.2023.02.006. Epub 2023 Mar 2.

The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis

Zhuoran Hu  1 , Hin Moi Youn  1 , Jianchao Quan  2 , Lily Luk Siu Lee  1 , Ivy Lynn Mak  1 , Esther Yee Tak Yu  1 , David Vai-Kiong Chao  3 , Welchie Wai Kit Ko  4 , Ian Chi Kei Wong  5 , Gary Kui Kai Lau  6 , Chak Sing Lau  7 , Cindy Lo Kuen Lam  8 , Eric Yuk Fai Wan  9
Affiliations
Meta-Analysis

The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis

Zhuoran Hu et al. Prim Care Diabetes. 2023 Jun.

Abstract

Background: The effect directly from the coronavirus disease 2019 (COVID-19) infection on health and fatality has received considerable attention, particularly among people with type 2 diabetes mellitus (T2DM). However, evidence on the indirect impact of disrupted healthcare services during the pandemic on people with T2DM is limited. This systematic review aims to assess the indirect impact of the pandemic on the metabolic management of T2DM people without a history of COVID-19 infection.

Methods: PubMed, Web of Science, and Scopus were systematically searched for studies that compared diabetes-related health outcomes between pre-pandemic and during-pandemic periods in people with T2DM and without the COVID-19 infection and published from January 1, 2020, to July 13, 2022. A meta-analysis was performed to estimate the overall effect on the diabetes indicators, including hemoglobin A1c (HbA1c), lipid profiles, and weight control, with different effect models according to the heterogeneity.

Results: Eleven observational studies were included in the final review. No significant changes in HbA1c levels [weighted mean difference (WMD), 0.06 (95% CI -0.12 to 0.24)] and body weight index (BMI) [0.15 (95% CI -0.24 to 0.53)] between the pre-pandemic and during-pandemic were found in the meta-analysis. Four studies reported lipid indicators; most reported insignificant changes in low-density lipoprotein (LDL, n = 2) and high-density lipoprotein (HDL, n = 3); two studies reported an increase in total cholesterol and triglyceride.

Conclusions: This review did not find significant changes in HbA1c and BMI among people with T2DM after data pooling, but a possible worsening in lipids parameters during the COVID-19 pandemic. There were limited data on long-term outcomes and healthcare utilization, which warrants further research.

Systematic review registration: PROSPERO CRD42022360433.

Keywords: COVID-19; Hemoglobin A1c; Indirect effect; Meta-analysis; Systematic review; Type 2 diabetes mellitus.

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Conflict of interest statement

Declaration of Competing Interest ICKW reports research funding from Amgen, Bristol Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, the National Institute for Health Research in England, the European Commission, and the National Health and Medical Research Council in Australia, outside the submitted work; and is a non-executive director of Jacobson Medical in Hong Kong and a consultant to IQVIA and World Health Organization. Other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA flowchart.
Fig. 2
Fig. 2
Changes in clinical parameters compared with the pre-pandemic HbA1%: glycated hemoglobin; BP: blood pressure; BMI: body mass index; TC: total cholesterol; TG: triglyceride; LDL: low-density lipoprotein; HDL: high-density lipoprotein.
Fig. 3
Fig. 3
Meta-analysis to assess the indirect impact of COVID-19 on HbA1c (%).
Fig. 4
Fig. 4
Meta-analysis to assess the indirect impact of COVID-19 on lipid parameters. *: converted from median (range).
Fig. 5
Fig. 5
Meta-analysis to assess the indirect impact of COVID-19 on BMI (Kg/m2). *: converted from median (range).
See this image and copyright information in PMC

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References

    1. Chen L., Zhang L., Xu X. Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge. BMC Health Serv. Res. 2020;20:1057. - PMC - PubMed
    1. Caron R.M., Adegboye A.R.A. COVID-19: a syndemic requiring an integrated approach for marginalized populations. Front. Public Health. 2021;9 - PMC - PubMed
    1. Wang B., Li R., Lu Z., Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging. 2020;12:6049–6057. - PMC - PubMed
    1. Hartmann-Boyce J., Morris E., Goyder C., Kinton J., Perring J., Nunan D., Mahtani K., Buse J.B., Del Prato S., Ji L., Roussel R., Khunti K. Diabetes and COVID-19: risks, management, and learnings from other national disasters. Diabetes Care. 2020;43:1695–1703. - PubMed
    1. Kastora S., Patel M., Carter B., Delibegovic M., Myint P.K. Impact of diabetes on COVID-19 mortality and hospital outcomes from a global perspective: an umbrella systematic review and meta-analysis. Endocrinol. Diabetes Metab. 2022;5 - PMC - PubMed

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