Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2020; 11(10): 468-480
Published online Oct 15, 2020. doi: 10.4239/wjd.v11.i10.468
Prevalence and impact of diabetes in patients with COVID-19 in China
Min Du, Yu-Xin Lin, Wen-Xin Yan, Li-Yuan Tao, Min Liu, Jue Liu
Min Du, Yu-Xin Lin, Wen-Xin Yan, Min Liu, Jue Liu, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Li-Yuan Tao, Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100083, China
Author contributions: Liu J conceived and designed the study; Du M and Yan WX carried out the literature searches; Du M, Yan WX, and Lin YX extracted the data; Du M, Lin YX, and Yan WX assessed the study quality; Du M performed the statistical analysis; Du M and Liu J wrote the manuscript; Liu J, Du M, Liu Min, and Tao LY revised the manuscript.
Supported by the National Natural Science Foundation of China, No. 71934002.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jue Liu, PhD, Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China. jueliu@bjmu.edu.cn
Received: April 19, 2020
Peer-review started: April 19, 2020
First decision: May 20, 2020
Revised: May 25, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: October 15, 2020
ARTICLE HIGHLIGHTS
Research background

Coronavirus disease 2019 (COVID-19) has spread around the world rapidly. The prevalence of diabetes varies across different studies. Previous studies showed that COVID-19 patients with diabetes were prone to having poor clinical outcomes. However, a systematical review of the prevalence of diabetes in COVID-19 patients and the impact of diabetes on clinical outcomes has not been done in China.

Research motivation

We hypothesized that the presence of diabetes is associated with a poor prognosis. To our knowledge, this is the first meta-analysis which focused on evaluating the prevalence of diabetes among patients with COVID-19 infection in China and its impact on clinical outcomes.

Research objectives

The aim of this study was to systematically evaluate the prevalence of diabetes among COVID-19 patients in China and its impact on clinical outcomes, including ICU admission, progression to severe cases, or death.

Research methods

A systematic review and meta-analysis of observational studies were performed.

Research results

Twenty-three eligible articles including 49564 COVID-19 patients (1573 with and 47991 without diabetes) were included. The pooled prevalence of diabetes was 10% [95% confidence interval (CI): 7%-15%] in COVID-19 patients. In the subgroup analyses, the pooled prevalence of diabetes was higher in studies on patients with a median age > 50 years (13%; 95%CI: 11%-16%) than studies on patients with a median age ≤ 50 years (7%; 95%CI: 6%-8%), in severe patients (17%; 95%CI: 14%-20%) than in non-severe patients (6%; 95%CI: 5%-8%), and in dead patients (30%; 95%CI: 13%-46%) than in survivors (8%; 95%CI: 2%-15%, all P < 0.05). Compared with patients without diabetes, the risks of severe cases [risk ratio (RR) = 2.13, 95%CI: 1.76-2.56, I2 = 49%] and death (RR = 3.16, 95%CI: 2.64-3.78, I2 = 34%) were both higher in COVID-19 patients with diabetes. However, diabetes was not found to be significantly associated with admission to ICU (RR = 1.16, 95%CI: 0.15-9.11).

Research conclusions

Nearly one in ten COVID-19 patients have diabetes in China. Diabetes is associated with a higher risk of severe illness and death. The present study suggested that targeted early intervention is needed in COVID-19 patients with diabetes.

Research perspectives

A systematic review and meta-analysis of observational studies which summarizes the evidence on this topic is meaningful. More adequate and vigorous research should be conducted to prove the associations found in this study.