Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2021; 10(5): 275-287
Published online Sep 25, 2021. doi: 10.5501/wjv.v10.i5.275
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
Processing time: 208 Days and 0.7 Hours
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 I2.

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

Core Tip: The relationship between diabetes and coronavirus disease 2019 (COVID-19) is known to be bidirectional. The rate of COVID-19 associated diabetes mellitus (DM) and hyperglycemia was significantly high. Higher mortality rates and adverse events were seen in patients with new-onset DM and hyperglycemia in comparison to the non-diabetic population.