Log in to MyACC
Diabetes Phenotype and COVID-19 Severity and Death
Quick Takes
- Higher risk of COVID-19–related death for individuals with diabetes was noted for those with male sex, older age, CVD, CKD, COPD, high plasma blood glucose at admission, and chronic insulin use.
- Metformin use was inversely associated with death.
- These findings can help identify people with diabetes and COVID-19 at high risk for poor outcomes and, therefore, those most likely to require early intensive and aggressive therapies.
Study Questions:
What are the high-risk phenotypes of diabetes associated with coronavirus disease 2019 (COVID-19) severity and death?
Methods:
The investigators conducted a living systematic review and meta-analysis on observational studies investigating phenotypes in individuals with diabetes and COVID-19 regarding death and COVID-19 severity. Four different databases were searched up to October 10, 2020. The authors used random-effects meta-analysis to calculate summary relative risks (SRRs) with 95% confidence intervals (CIs). The certainty of evidence was evaluated by GRADE. This study is registered with PROSPERO, CRD42020193692.
Results:
A total of 22 articles met the inclusion criteria. There was high to moderate certainty of evidence for associations between male sex (SRR, 1.28; 95% CI, 1.02-1.61; n = 10 studies), older age (>65 years: SSR, 3.49; 95% CI, 1.82-6.69; n = 6), pre-existing comorbidities (cardiovascular disease [CVD]: SSR, 1.56; 95% CI, 1.09-2.24; n = 8; chronic kidney disease [CKD]: SSR, 1.93; 95% CI, 1.28-2.91; n = 6; chronic obstructive pulmonary disease [COPD]: SSR, 1.40; 95% CI, 1.21-1.62; n = 5), diabetes treatment (insulin use: SSR, 1.75; 95% CI, 1.01-3.03; n = 5; metformin use: SSR, 0.50; 95% CI, 0.28-0.90; n = 4), and blood glucose at admission (blood glucose ≥11 mmol/L: SRR, 8.60; 95% CI, 2.25-32.83; n = 2) regarding death among individuals with diabetes and COVID-19. Similar, but in general weaker and less precise, associations were observed for severity of COVID-19.
Conclusions:
The authors concluded that individuals with a more severe course of diabetes have a poorer prognosis of COVID-19 compared to individuals with a milder course of disease.
Perspective:
This systematic review and meta-analysis reports higher risk of COVID-19–related death for individuals with diabetes and male sex, older age, CVD, CKD, COPD, high plasma blood glucose at admission, and chronic insulin use. Of note, metformin use was inversely associated with death. Overall, the risk group identified for the population with diabetes and COVID-19 (i.e., older individuals with comorbid conditions and using insulin) may just indicate severity of diabetes or poor health conditions per se. However, these findings can help identify people with diabetes and COVID-19 at high risk for poor outcomes and, therefore, those most likely to require early intensive and aggressive therapies.
Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Prevention
Keywords: Blood Glucose, Comorbidity, Coronavirus, COVID-19, Diabetes Mellitus, Geriatrics, Hyperglycemia, Insulin, Kidney Diseases, Metabolic Syndrome, Metformin, Phenotype, Plasma, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Renal Insufficiency, Chronic, Risk Factors
< Back to Listings
