Risks of and From SARS-CoV-2 Infection and COVID-19 in People With Diabetes: a Systematic Review of Reviews
Version 2 2023-10-19, 16:47
Version 1 2021-10-28, 16:15
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posted on 2023-10-19, 16:47 authored by Jamie Hartmann-Boyce, Karen Rees, James C Perring, Sven A Kerneis, Elizabeth M. Morris, Clare Goyder, Afolarin A. Otunla, Olivia A James, Nandana R Syam, Samuel Seidu, Kamlesh KhuntiBackground
<p>This
review was commissioned by the World Health Organization and presents a summary
of the latest research evidence on the impact of COVID-19 in people with diabetes
(PWD).</p>
<p>Purpose </p>
<p>To
review the evidence regarding the extent to which PWD are at increased risk of
SARS-CoV-2 infection, and/or of suffering its complications including
associated mortality.</p>
<p>Data sources</p>
<p>We
searched the Cochrane COVID-19 study register, Embase, MEDLINE, and LitCOVID on
3 December 2020.</p>
<p>Study selection</p>
<p>Systematic
reviews synthesising data on PWD exposed to SARS-CoV-2 infection, reporting
data on confirmed SARS-CoV-2 infection, admission to hospital and/or to ICU
with COVID-19, death with COVID-19.</p>
<p>Data extraction</p>
<p>One
reviewer appraised and extracted data; data were checked by a second.</p>
<p>Data synthesis</p>
<p>Data
from 112 systematic reviews were narratively synthesised and displayed using
effect direction plots. Reviews provided consistent evidence that diabetes is a
risk factor for severe disease and death from COVID-19. There was less data
available on ICU admission, but where available this data also signalled
increased risk. Within PWD, higher blood glucose levels both prior to COVID-19
illness and during COVID-19 illness were associated with worse COVID-19
outcomes. Type 1 diabetes was associated with worse outcomes compared to type 2
diabetes. There was no appropriate data for discerning whether diabetes was a
risk factor for acquiring SARS-CoV-2 infection.</p>
<p>Limitations</p>
<p>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.</p>
<p>Conclusions</p>
<p>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.</p>
Funding
WHO commissioned and financially supported this work. KK is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre (BRC). EM and CG are supported by Wellcome Trust Doctoral Research Fellowships [grant number 203921].
History
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