Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2020; 11(10): 468-480
Published online Oct 15, 2020. doi: 10.4239/wjd.v11.i10.468
Prevalence and impact of diabetes in patients with COVID-19 in China
Min Du, Yu-Xin Lin, Wen-Xin Yan, Li-Yuan Tao, Min Liu, Jue Liu
Min Du, Yu-Xin Lin, Wen-Xin Yan, Min Liu, Jue Liu, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Li-Yuan Tao, Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100083, China
Author contributions: Liu J conceived and designed the study; Du M and Yan WX carried out the literature searches; Du M, Yan WX, and Lin YX extracted the data; Du M, Lin YX, and Yan WX assessed the study quality; Du M performed the statistical analysis; Du M and Liu J wrote the manuscript; Liu J, Du M, Liu Min, and Tao LY revised the manuscript.
Supported by the National Natural Science Foundation of China, No. 71934002.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jue Liu, PhD, Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China. jueliu@bjmu.edu.cn
Received: April 19, 2020
Peer-review started: April 19, 2020
First decision: May 20, 2020
Revised: May 25, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: October 15, 2020
Processing time: 177 Days and 18.5 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has spread rapidly around the world. Previous studies have indicated that COVID-19 patients with diabetes are prone to having poor clinical outcomes.

AIM

To systematically evaluate the prevalence of diabetes among COVID-19 patients in China and its impact on clinical outcomes, including ICU admission, progression to severe cases, or death.

METHODS

We searched studies published in PubMed, Web of Science, and EMBASE from December 1, 2019 to March 31, 2020 to identify relevant observational study that investigated the prevalence of diabetes among COVID-19 patients or its impact on clinical outcomes. We used a random-effects or fixed-effects model to estimate the pooled prevalence of diabetes and risk ratio (RR) and its 95% confidence interval (CI) of diabetes on outcomes. Funnel plots were used to evaluate the publication bias and the heterogeneity was evaluated by I2 statistic.

RESULTS

Twenty-three eligible articles including 49564 COVID-19 patients (1573 with and 47991 without diabetes) were finally included. The pooled prevalence of diabetes was 10% (95%CI: 7%-15%) in COVID-19 patients. In the subgroup analyses, the pooled prevalence of diabetes was higher in studies with patients aged > 50 years (13%; 95%CI: 11%-16%) than in studies with patients aged ≤ 50 years (7%; 95%CI: 6%-8%), in severe patients (17%; 95%CI: 14%-20%) than in non-severe patients (6%; 95%CI: 5%-8%), and in dead patients (30%; 95%CI: 13%-46%) than in survivors (8%; 95%CI: 2%-15%) (P < 0.05 for all). Compared with patients without diabetes, the risk of severe cases was higher (RR = 2.13, 95%CI: 1.76-2.56, I2 = 49%) in COVID-19 patients with diabetes. The risk of death was also higher in COVID-19 patients with diabetes (RR = 3.16, 95%CI: 2.64-3.78, I2 = 34%). However, diabetes was not found to be significantly associated with admission to ICU (RR = 1.16, 95%CI: 0.15-9.11).

CONCLUSION

Nearly one in ten COVID-19 patients have diabetes in China. Diabetes is associated with a higher risk of severe illness and death. The present study suggested that targeted early intervention is needed in COVID-19 patients with diabetes.

Keywords: Diabetes; COVID-19; Systematic review; Meta-analysis

Core Tip: At present, the prevalence and impact of diabetes in patients with coronavirus disease 2019 (COVID-19) have not been systematically reviewed in China. This meta-analysis for the first time focused on the pooled prevalence of diabetes among COVID-19 patients and its impact on clinical outcomes (ICU admission, severity, and death) in China. The analysis showed that the pooled prevalence of diabetes was 10% [95% confidence interval (CI): 7%-15%] in COVID-19 patients. Besides, the risks of severe cases (risk ratio = 2.13, 95%CI: 1.76-2.56, I2 = 49%, P = 0.007) and deaths (risk ratio = 3.16, 95%CI: 2.64-3.78, I2 = 34%, P = 0.20) were both higher in COVID-19 patients with diabetes compared with those without. Our findings highlight the need for targeted intervention on diabetes among COVID-19 patients.