Global prevalence of diabetes associated with severity of COVID-19

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New data show the prevalence of diabetes in serious cases and deceased COVID-19 is almost 50% higher than in all hospitalized patients, indicating a correlation between the severity of COVID-19 and the global prevalence of diabetes.¹

Researchers from the Sino-Australian Joint Research Center for Infectious Diseases found that diabetes contributed to 9.5% of severe COVID-19 cases and 16.8% of deaths, with variations by country income , accessibility to health care and the burden of disease.

“High prevalence of diabetes and prediabetes in the population may be a public health concern during the COVID outbreak,” the investigators wrote. “A strategy of sufficient community diabetes screening and optimal glycemic control for people with diabetes should be effective in preventing COVID-19-related severity and mortality.”

Over the years, viral pandemics, including the 2003 Severe Acute Respiratory Syndrome (SARS) pandemic and the 2009 Influenza A (H1N1) pandemic, have suggested that people with diabetes are at significantly higher risk of develop a serious illness. The current large global burden of disease from both COVID-19 and diabetes is likely to be a significant public health issue worldwide, making it crucial to quantify the impact of diabetes on the pandemic and develop management strategies to mitigate its risk.

The survey team led by Lei Zhang and Guihua Zhuang sought to quantify the prevalence of diabetes at various stages of COVID-19 disease globally, regionally and nationally and to estimate the population attributable fraction (PAF) of the diabetes to severity and severity related to COVID-19. mortality. The investigators systematically searched PubMed, Embase, and Web of Science to identify peer-reviewed studies up to May 2022 on the prevalence of diabetes in various stratification groups of individuals with a confirmed diagnosis of COVID-19. Studies of any design were eligible for inclusion, provided that each reported the prevalence of diabetes in subjects with known diagnosis, severity or outcome, according to the researchers.

A random-effects meta-analysis was used to estimate the overall prevalence of diabetes among COVID-19 positive individuals and stratify individuals into subgroups based on severity and outcome. Subgroup analyzes were performed based on pandemic wave of COVID-19, geographic region, country income level, health care access and quality (HAQ) of a country and a country’s disease burden.

Overall, a total of 29,874,938 individuals diagnosed with SARS-CoV-2 infection from 60 countries were included in the meta-analysis. The results showed that the global prevalence of diabetes increased in groups of individuals with COVID-19 with increasing disease severity.

The combined prevalence of diabetes was 14.7% (95% confidence interval [CI], 12.5 – 16.9) in confirmed cases, while diabetes was present in 10.4% (95% CI, 7.6 – 13.6) of non-hospitalized cases and 21.4% (CI 95%, 20.4 – 22.5) of hospitalized cases. Additionally, among those hospitalized, the prevalence of diabetes was 11.9% (95% CI, 10.2 – 13.7) in non-severe cases, 28.9% (95% CI, 27 .0 – 30.8) in severe cases and 34.6% (95% CI, 32.8 – 36.5) in impaired individuals.

Subgroup analyzes indicated that heterogeneity in pooled prevalence may result from temporal and geographic trends, a country’s income and HAQ, and a country’s diabetes disease burden. A multivariate meta-regression analysis revealed that all included variables combined could explain 53-83% of the heterogeneity in the combined prevalence of diabetes in various COVID-19 groups.

Using a modified version of the comparative risk assessment model, the investigators estimated the overall diabetes PAF of 9.5% (95% CI, 7.3 – 11.7) for the presence of severe illness in COVID-19 cases and 16.8% (95% CI, 14.8 – 18.8) for COVID-19 related deaths. The team noted that countries with high income levels, high HAQ and low diabetes disease burden had lower diabetes FAP contributing to the disease burden of COVID-19.

“To the best of our knowledge, this is the first study to quantify the impact of diabetes on the adverse effects of COVID-19 globally,” the investigators wrote. “This finding reinforces that people with diabetes are more likely to progress to serious complications when infected with SARS-CoV-2.”

The references

1. Rui Li, Mingwang Shen, Qianqian Yang, Christopher K. Fairley, Zhonglin Chai, Robert McIntyre, Jason J. Ong, Hanting Liu, Pengyi Lu, Wenyi Hu, Zhuoru Zou, Zengbin Li, Shihao He, Guihua Zhuang, Lei Zhang; diabetes Prevalence in patients with COVID-19 and contribution to COVID-19-related severity and mortality: a systematic review and meta-analysis. Diabetes Care, April 1, 2023; 46 (4): 890–897. https://doi.org/10.2337/dc22-1943