- 18% of all patients had the composite endpoint
- Odds ratio influenced by age (higher age, lower ratio)
- Diabetes was observed to be associated with both mortality of and severe COVID-19 with a pooled odds ratio of 1.90 and 2.75 respectively. 
- Patients with diabetes and COVID-19 have shown a two-fold increase in mortality and severity compared to non-diabetics
- Further studies need to be conducted to better understand this relationship


Results of Is Diabetes Mellitus Associated with Mortality and Severity of COVID-19? A Meta-analysis

The meta-analysis searched PubMed for case-control studies published from January 1 through April 22, 2020. It included 33 observational studies involving 16,003 adults, of whom 54% were male and 1,724 had diabetes; the mean age was 52.6 ± 17.4 years. Mortality was the outcome in studies comparing survival and death, while other severity outcomes included invasive ventilation and intensive care unit admission.

Materials and Methods of Is Diabetes Mellitus Associated with Mortality and Severity of COVID-19? A Meta-analysis

Princeton University

University of Michigan - Ann Arbor

Among 174 patients, the median age is 59 (age range: 49-67) and 76 out of 174 are men. Compared with patients without diabetes, patients with diabetes had more cardiovascular disease (32.4% vs 14.6%) and less fever (59.5% vs 83.2%), but had no significant differences in gender and age. Diabetes group has lower lymphocytes, red blood cells, and hemoglobin than non-diabetes group. These data showed that the COVID‐19 patients with diabetes are at higher risk of excessive uncontrolled inflammation responses and hypercoagulable state, which may contribute to a poorer prognosis of COVID‐19. Diabetes should be considered as a risk factor for a rapid progression and bad prognosis of COVID‐19. More intensive attention should be paid to patients with diabetes, in case of rapid deterioration

- Note: for more journal articles supporting this claim, please see the children of this node.

Diabetes is a risk factor for the progression and prognosis of COVID-19

Kumar A, Arora A, Sharma P, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020;14(4):535-545. doi:10.1016/j.dsx.2020.04.044

Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis

Researchers conducted a cohort study in which data from people with either type 1 or type 2 diabetes in England was collected from death registrations to analyze potential risk factors for COVID-19-related mortality.  It was found that being of male sex and being of older age was linked to a higher risk of COVID-19-related mortality in both type 1 and type 2 diabetic individuals.  Preceding hyperglycaemia and impaired renal function were also found to cause a significant increase in risk of COVID-19-related mortality for both type 1 and 2 diabetes.  Specifically, for individuals with type 2 diabetes, having an HbA1c of 59 mmol/mol caused a significantly elevated risk for COVID-19-related mortality than those who had HbA1c of 48–53 mmol/mol.  

Risk Factors for COVID-19-Related Mortality in People with Type 1 and Type 2 Diabetes

Diabetes is a major comorbidity of COVID-19, associated with more severe disease and higher mortality. Proposed mechanisms include increased ACE2 expression that may facilitate SARS-CoV-2 cell entry, and chronic hyperglycemia that impairs immune function and drives inflammation (e.g., elevated IL-6). Across cohorts in Wuhan (China), Mexico, Italy, England, and Saudi Arabia, diabetes is consistently overrepresented among COVID-19 patients, and the degree of hyperglycemia at admission—especially newly diagnosed diabetes—predicts worse outcomes. Some diabetes medications also show differential associations with COVID-19 mortality. This node organizes prevalence/pathophysiology, geographic patterns, hyperglycemia effects, medication effects, and endocrine-society guidance for the comorbidity.

Diabetes as a Comorbidity of COVID-19

1. diabetes patients often suffer from comorbidities which further worsen clinical outcomes and how to adapt to glucose-lowering therapy
2. access of diabetes patients to outpatient clinics is limited during the ongoing season urging alternative treatment options, particularly the implementation of novel telemedicine strategies.

Diabetes and COVID-19 : Disease-Management-People

- Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID‐19

Diabetes, Obesity, and Metabolism Papers Related to COVID-19 Patient Comorbities

The pooled analysis reports that COVID-19 patients with diabetes have higher risks of disease progression and mortality than patients without diabetes. Hyperglycemia may contribute by impairing immune responses and increasing inflammation.

Pooled-analysis association between diabetes and COVID-19 severity and mortality

In the reported study, COVID-19 patients with pre-existing diabetes had higher D-dimer levels and more severe disease than those without diabetes. This association suggests that D-dimer may be a useful biomarker of COVID-19 severity in patients with diabetes.

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