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An extensive meta-analysis of patients with COVID-19 and diabetes “provides the best current evidence” to determine the risk of severe COVID-19 or its death based on characteristics and laboratory values of patients and diabetes, researchers report.
Male sex, older age, pre-existing comorbidities (cardiovascular diseases, chronic kidney diseases and chronic obstructive pulmonary diseases) [COPD]), Insulin use, and high blood sugar at hospitalization were associated with an increased risk of COVID-19-related death, while metformin use was associated with a lower risk due to moderate to strong evidence.
The same traits were associated with similar risks of having (or not having) severe COVID-19 based on weaker evidence.
“Taken together, the risk group we have identified for the population with diabetes and COVID-19, i.e. older people with comorbid conditions and insulin use, could simply reflect the severity of diabetes or poor health conditions per se,” warn the researchers.
“Still, considering these phenotypes 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 need intensified treatment early,” they conclude.
The meta-analysis of 22 studies and 17,687 people with diabetes and COVID-19 by Sabrina Schlesinger, PhD, Heinrich-Heine-Universität, Düsseldorf, Germany, and colleagues was published in Diabetologia on April 28th.
Which diabetes patients are at higher risk?
Diabetes increases the risk of dying from COVID-19, but the patient characteristics and diabetes-related factors associated with the increased risk for the severity or death of COVID-19 are not fully understood.
To investigate this, the researchers identified studies published by October 10, 2020 in patients with type 2 and, less commonly, type 1, diabetes and COVID-19.
Compared to women, in 10 studies and 11 studies with high quality evidence, men had a 28% increased risk of dying from COVID-19 and a 36% increased risk of severe COVID-19.
Compared to younger patients, patients over 65 in 6 studies with moderate evidence had a 3.5 times higher risk of death from COVID-19 and a 67% higher risk of serious illness.
However, there were no clear associations between smoking or being overweight or obese and COVID-19-related death or severity.
In general, few studies examined the associations between diabetes-specific risk factors or laboratory markers and outcomes.
Blood glucose> 11 mmol / L versus <6 mmol / L at intake was associated with an 8.6-fold increased risk of death from COVID-19.
Compared to other patients, those who used insulin (and likely had more advanced type 2 diabetes) were 75% more likely to die from COVID-19.
Conversely, patients who received metformin (likely primarily for first-line therapy for type 2 diabetes) were 50% less likely to die with COVID-19 than other patients.
As in the general population, comorbidities predicted worse outcomes. COPD was associated with a 21% increased risk of death from COVID-19 and a 36% increased risk of severe COVID-19.
Cardiovascular disease or chronic kidney disease were associated with a 56% and 93% increased risk of dying from COVID-19, respectively, due to weaker evidence.
Obesity and high blood pressure did not predict worse results in this analysis
Patients with diabetes had “with a few exceptions” similar risk factors for poorer outcomes as people in the general population.
“Older age, male sex, obesity, high blood pressure, chronic lung disease, [cardiovascular disease], active cancer, laboratory parameters (e.g., low lymphocyte counts and increases in [C-reactive protein (CRP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST)]) have been associated with a poor prognosis of COVID-19 in the general population infected with SARS-CoV-2, “write Schlesinger and colleagues.
“Interestingly,” however, the meta-analysis did not find that obesity or high blood pressure were associated with an increased risk of severe COVID-19 or death from COVID-19.
There were no clear associations for CRP (the most commonly measured biomarker of inflammation) or liver enzymes (ALT, AST) and worse results, but this was based on limited data.
Ask for more research
“In order to strengthen the evidence, further primary studies are required in which diabetes-specific risk factors such as the type and duration of diabetes or additional comorbidities (such as liver disease and neuropathy) are examined and important confounding factors are taken into account,” the researchers demand.
“We will continuously update this report to bolster the evidence of associations that have already been studied and to investigate additional findings such as long-term complications from COVID-19 in people with diabetes,” they conclude.
Diabetologia. Published online April 28, 2021. Article.
The study was funded by the DEAL project and a grant from the Federal Ministry of Education and Research to the German Center for Diabetes Research (DZD). Schlesinger has not disclosed any relevant financial relationships. The statements of the other authors are listed in the article.
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