New-onset diabetes in COVID-19 and clinical outcomes: A systematic review and meta-analysis

Dhan Bahadur Shrestha; Pravash Budhathoki; Sumit Raut; Sugat Adhikari; Prinska Ghimire; Sabin Thapaliya; Ali A Rabaan; Bibodh Jung Karki

doi:10.5501/wjv.v10.i5.275

New-onset diabetes in COVID-19 and clinical outcomes: A systematic review and meta-analysis

World J Virol. 2021 Sep 25;10(5):275-287. doi: 10.5501/wjv.v10.i5.275.

Authors

Dhan Bahadur Shrestha¹, Pravash Budhathoki², Sumit Raut³, Sugat Adhikari⁴, Prinska Ghimire⁵, Sabin Thapaliya⁶, Ali A Rabaan⁷, Bibodh Jung Karki⁸

Affiliations

¹ Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, United States. medhan75@gmail.com.
² Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, United States.
³ Department of Emergency Medicine, Kathmandu Medical College, Kathmandu 44600, Nepal.
⁴ Department of Internal Medicine, Nishtar Medical University, Multan 59330, Pakistan.
⁵ Department of Internal Medicine, Tribhuvan University, Kathmandu 44600, Nepal.
⁶ Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal.
⁷ Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia.
⁸ Division of Infectious Diseases, University of Louisville, Louisville, KY 40292, United States.

Abstract

Background: Diabetes mellitus (DM) is associated with adverse clinical outcomes and high mortality in patients with coronavirus disease 2019 (COVID-19). The relationship between diabetes and COVID-19 is known to be bidirectional.

Aim: To analyze the rate of new-onset diabetes in COVID-19 patients and compare the clinical outcomes of new-onset diabetes, pre-existing diabetes, hyperglycemic, and non-diabetes among COVID-19 patients.

Methods: We used the Meta-analysis of Observational Studies in Epidemiology statement for the present meta-analysis. Online databases were searched for all peer-reviewed articles published until November 6, 2020. Articles were screened using Covidence and data extracted. Further analysis was done using comprehensive meta-analysis. Among the 128 studies detected after thorough database searching, seven were included in the quantitative analysis. The proportion was reported with 95% confidence interval (CI) and heterogeneity was assessed using I ².

Results: Analysis showed that 19.70% (CI: 10.93-32.91) of COVID-19 patients had associated DM, and 25.23% (CI: 19.07-32.58) had associated hyperglycemia. The overall mortality rate was 15.36% (CI: 12.57-18.68) of all COVID-19 cases, irrespective of their DM status. The mortality rate was 9.26% among non-diabetic patients, 10.59% among patients with COVID-19 associated hyperglycemia, 16.03% among known DM patients, and 24.96% among COVID-19 associated DM patients. The overall occurrence of adverse events was 20.52% (CI: 14.21-28.70) among COVID-19 patients in the included studies, 15.29% among non-diabetic patients, 20.41% among patients with COVID-19 associated hyperglycemia, 20.69% among known DM patients, and 45.85% among new-onset DM. Meta-regression showed an increasing rate of mortality among new hyperglycemic patients, known diabetics, and new-onset DM patients in comparison to those without diabetes.

Conclusion: A significantly higher rate of new onset DM and hyperglycemia was observed. Higher mortality rates and adverse events were seen in patients with new-onset DM and hyperglycemia than in the non-diabetic population.

Keywords: Acute respiratory distress syndrome; COVID-19; Diabetes mellitus; Hyperglycemia; Mortality.