Excessive blood glucose at admission, insulin use increase threat for COVID-19 mortality in diabetes

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April 29, 2021

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Schlesinger does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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People with diabetes who have elevated blood sugar levels upon ingestion and people who take insulin are at increased risk for COVID-19 mortality. This emerges from data from a systematic review and meta-analysis published in Diabetologia.

“People with a more severe history of diabetes have a worse prognosis for COVID-19 than people with a milder history of diabetes.” Sabrina Schlesinger, PhD, Head of the junior research group for systematic reviews at the German Diabetes Center in Düsseldorf, told Healio. “These results can be helpful in identifying people with diabetes and COVID-19 who are at high risk for poor outcomes and therefore those who are most likely to require early vaccination or early intensified treatment.”

Hospital admission blood sugar and insulin use increase the risk of COVID-19-related mortality in diabetes, while metformin decreases the risk. The data were provided by Schlesinger S, et al. Diabetologia. 2021; doi: 10.1007 / s00125-021-05458-8.

Schlesinger and colleagues conducted a systematic review and meta-analysis of studies analyzing the risk of severe COVID-19 or related death in people with diabetes. The researchers searched PubMed, Web of Science, Epistemonikos, and the COVID-19 research database for studies up to October 10, 2020. The summary relative risks were calculated, and two authors independently rated the safety of each pooled association as very low, low, moderate or high one.

There were 22 studies with a total of 17,687 participants with diabetes in the analysis. Fourteen of the 22 studies were conducted in Asia, five in North America and three in Europe. Most of the studies were conducted in the hospital, one using data from a national registry and two health insurance records.

Several associations with moderate or high certainty of evidence were observed. Men with diabetes were at an increased risk of COVID-19-related mortality (summary RR [SRR] = 1.28; 95% CI, 1.02-1.61) and severe COVID-19 (SRR = 1.36; 95% CI, 1.13-1.64) compared to women. People with diabetes aged 65 and over were at a higher risk of death from COVID-19 compared to younger adults (SRR = 3.49; 95% CI, 1.82-6.69). With every 5 year increase in age, the risk of COVID-19-related mortality increased by 43% and the risk of severe COVID-19 increased by 25%.

Few studies examined diabetes-specific factors related to COVID-19, which means that the certainty of evidence was largely low or very low. From associations with moderate or high certainty, people with a blood sugar level of more than 11 mmol / l at the first ingestion had an increased risk of COVID-19-related death (SRR = 8.6; 95% CI, 2.25-32 , 83). Those who were chronic insulin users also had a higher risk of COVID-19-related mortality compared to people who did not use insulin (SRR = 1.75; 95% CI, 1.01-3.03) and metformin Consumers had a lower risk of COVID-19 related mortality compared to those who did not use metformin (SRR = 0.5; 95% CI, 0.28-0.9).

Participants with chronic obstructive pulmonary disease were at increased risk of COVID-19-related mortality (SRR = 1.4; 95% CI, 1.21-1.62) and severe COVID-19 (SRR = 1.36; 95% CI , 1.11-1.66). There were also moderately strong associations for an increased risk of COVID-19-related mortality in people with cardiovascular disease (SRR = 1.56; 95% CI, 1.09-2.24) and chronic kidney disease (SRR = 1.93; 95% CI, 1.28) found -2.9).

“Hypertension and obesity have been identified as risk factors for the severity of COVID-19 in the general population,” said Schlesinger. “Surprisingly, these risk factors were not identified in this meta-analysis for patients with diabetes. However, more studies on the subject are needed. “

Schlesinger said the live systematic review and meta-analysis will continue to be updated as more relevant studies become available and that more studies are needed that explicitly focus on diabetes-specific factors and their associations with severe COVID-19 and COVID-19 related mortality .

For more informations:

Sabrina Schlesinger, PhDcan be reached at sabrina.schlesinger@ddz.de.

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