Association of Diabetes and Severe COVID-19 Outcomes: A Rapid Review and Meta-Analysis

Mmamapudi Kubjane, Nicole McCreedy, Bertrand Cariou, Miguel A. Rubio, Ulrik Haagen Panton, Christian Hvid, Nadilka Hettiarachchige, Helen Mearns


Background: Addressing the urgent need for evidence on diabetes as a serious comorbidity for severe illness and death from coronavirus disease 2019 (COVID-19), we investigated the association between diabetes and COVID-19 disease severity in patients hospitalized due to COVID-19.

Methods: This rapid review and meta-analysis was undertaken in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE and EMBASE were searched for studies published between January 1 and May 20, 2020. Studies included were English language, peer-reviewed, observational studies of adults hospitalized for COVID-19 with reported clinical course and living with or without diabetes. The severity of clinical course was assessed using a composite outcome (mortality, admittance to intensive care unit (ICU), requirement for invasive mechanical ventilation (IMV), clinically defined severe or critical disease). Data and adjusted measures of association were extracted from published reports, and meta-analysis was performed using a random effects model. The protocol was registered with OSF ().

Results: A literature search yielded 431 articles, of which 45 studies (22,091 patients) met the inclusion criteria and 14 studies (12,383 patients) reported an adjusted measure of association for diabetes with the composite outcome with pooled hazard ratio 1.59 (95% confidence interval 1.3 - 1.93; I2 = 0%, P = 0.820) and pooled odds ratio of 2.15 (95% confidence interval 1.63 - 2.83; I2 = 0%, P = 0.892); evidence by GRADE was moderate.

Conclusions: People living with diabetes are more likely to develop severe COVID-19 clinical course if hospitalized for COVID-19 than people not living with diabetes. To inform clinical decision-making during the pandemic, our findings support that people living with diabetes who are hospitalized for COVID-19 should be prioritized when triaged as at increased risk for the development of severe clinical course.

J Endocrinol Metab. 2020;10(5):118-130


Diabetes; COVID-19; Severe COVID-19 outcomes; Meta-analysis

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