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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Dhan Bahadur Shrestha, Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, United States
Pravash Budhathoki, Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, United States
Sumit Raut, Department of Emergency Medicine, Kathmandu Medical College, Kathmandu 44600, Nepal
Sugat Adhikari, Department of Internal Medicine, Nishtar Medical University, Multan 59330, Pakistan
Prinska Ghimire, Department of Internal Medicine, Tribhuvan University, Kathmandu 44600, Nepal
Sabin Thapaliya, Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
Ali A Rabaan, Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia
Ali A Rabaan, Department of Public Health & Nutrition, The University of Haripur, Haripur 22620, Pakistan
Bibodh Jung Karki, Division of Infectious Diseases, University of Louisville, Louisville, KY 40292, United States
Author contributions: Shrestha DB, Budhathoki P, Adhikari S, Thapaliya S and Rabaan AA contributed to the concept and design of the work; Shrestha DB, and Budhathoki P analyzed and interpreted the data; Shrestha DB, Budhathoki P, Raut S, Adhikari S, and Ghimire P contributed to the literature search, data extraction, review and initial manuscript drafting; Thapaliya S, Rabaan AA and Karki BJ helped in interpretation of the data and revising the manuscript for important intellectual content; all authors were involved in drafting and revising the manuscript and approved the final version.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Dhan Bahadur Shrestha, MD Resident physician, Doctor, Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA. medhan75@gmail.com
Received: February 20, 2021
Peer-review started: February 20, 2021
First decision: May 14, 2021
Revised: May 16, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 25, 2021
ARTICLE HIGHLIGHTS
Research background
Diabetes has been shown to be associated with worsening severity of disease and poor prognosis in coronavirus disease 2019 (COVID-19). Interestingly, various cases of new onset diabetes mellitus (DM) were seen in patients with COVID-19. The virus is believed to bind to angiotensin-converting enzyme-2 receptors leading to increased angiotensin II and subsequent decreased insulin secretion.
Research motivation
In relation to various theories and proposed mechanisms of how COVID-19 may lead to abnormal glucose homeostasis, our study was conducted to evaluate new onset DM in COVID-19.
Research objectives
The study aimed to pool the prevalence of new onset DM and hyperglycemia in COVID-19 patients and compare various outcomes such as mortality, intubation and complications among infected patients who had hyperglycemia or preexisting DM or new onset DM or normal blood sugar levels.
Research methods
Meta-analysis of Observational Studies in Epidemiology was used for the meta-analysis. Studies were screened using Covidence after searching various databases including PubMed, PubMed Central, Embase and Scopus. Comprehensive meta-analysis software was used for data analysis.
Research results
The results showed that 19.70% and 25.23% of patients had COVID-19 associated DM and hyperglycemia, respectively. The mortality rate was highest among COVID-19 associated DM patients (24.96%) followed by patients with preexisting DM (16.03%), and was least in non-diabetic patients (9.29%). The occurrence of adverse events was highest among COVID-19 associated new-onset DM patients followed by patients with preexisting DM, COVID-19 associated hyperglycemia and non-diabetic patients.
Research conclusions
COVID-19 was associated with hyperglycemia and new-onset DM. Infected patients with new onset DM had worse prognosis in terms of mortality and adverse events.
Research perspectives
The findings of this study should alarm clinicians that new onset diabetes and hyperglycemia is a bad prognostic factor for COVID-19.
