Global diabetes prevalence in COVID-19 patients and contribution to COVID-19-related severity and mortality: a systematic review and meta-analysis

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posted on 2023-02-24, 16:40 authored by Rui Li, Mingwang Shen, Qianqian YangQianqian Yang, Christopher K. Fairley, Zhong Lin. Chai, ROBERT MCINTYREROBERT MCINTYRE, Jason J. Ong, Hanting Liu, Pengyi Lu, Wenyi Hu, Zhuoru Zou, Zengbin Li, Shihao He, Guihua Zhuang, Lei Zhang

BACKGROUND: COVID-19 and diabetes both contribute to large global disease burdens.

PURPOSE: To quantify the prevalence of diabetes in various COVID-19 disease stages and calculate the population attributable fraction (PAF) of diabetes to COVID-19-related severity and mortality

DATA SOURCES: Systematic review identified 729 studies with 29,874,938 COVID-19 patients.

STUDY SELECTION: Studies detailed the prevalence of diabetes in subjects with known COVID-19 diagnosis and severity.

DATA EXTRACTION: Study information, COVID-19 disease stages and diabetes prevalence were extracted.

DATA SYNTHESIS: The pooled prevalence of diabetes in stratified COVID-19 groups was 14.7% (95%CI: 12.5–16.9) among confirmed cases, 10.4% (7.6–13.6) among non-hospitalized cases, 21.4% (20.4–22.5) among hospitalized cases, 11.9% (10.2–13.7) among non-severe cases, 28.9% (27.0–30.8) among severe cases and 34.6% (32.8–36.5) among deceased subjects, respectively. Multivariate meta-regression analysis explained 53–83% heterogeneity of the pooled prevalence. Based on a modified version of the comparative risk assessment model, we estimated that the overall PAF of diabetes was 9.5% (7.3–11.7) for the presence of severe disease in COVID-19 individuals and 16.8% (14.8–18.8) for COVID-19-related deaths. Subgroup analyses demonstrated that countries with high-income levels, high healthcare access and quality index (HAQ) and low diabetes disease burden had lower PAF of diabetes contributing to COVID-19 severity and death.

LIMITATIONS: Most studies had a high risk of bias.

CONCLUSIONS: The prevalence of diabetes increases with COVID-19 severity and diabetes accounts for 9.5% of severe COVID-19 cases and 16.8% of deaths, with disparities according to country income, HAQ, and diabetes disease burden.