Global Prevalence of Diabetes Associated with COVID-19 Severity

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

Researchers from the China-Australia 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 depending on country income, healthcare accessibility, and disease burden.

“A high population prevalence of diabetes and prediabetes may be a public health concern during the COVID epidemic,” investigators wrote. “A strategy of sufficient diabetes screening in the community and optimal glucose control for those with diabetes should be effective to prevent 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 those with diabetes have a significantly greater risk of severe disease outcomes. The current large global burden of disease due to both COVID-19 and diabetes is likely to be a significant public health concern worldwide, making it crucial to quantify the impact of diabetes on the pandemic and develop management strategies to mitigate its risk.

The investigative team led by Lei Zhang and Guihua Zhuang looked to quantify the prevalence of diabetes in various COVID-19 disease stages at the global, regional, and country levels and estimate the population attributable fraction (PAF) of diabetes to COVID–related severity and mortality. 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 confirmed COVID-19 diagnosis. Studies of any design were eligible for inclusion, provided each reported the prevalence of diabetes in subjects with known diagnosis, severity, or outcomes, according to investigators.

A random-effects meta-analysis was used to estimate the overall prevalence of diabetes in COVID-19–positive individuals and stratify individuals into subgroups according to severity and outcomes. Subgroup analyses were performed according to COVID-19 pandemic wave, geographic regional, level of country income, a country’s health care access and quality (HAQ), 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. Results showed the global prevalence of diabetes increased in groups of individuals with COVID-19 with increasing severity of disease.

The pooled 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% (95% CI, 20.4 – 22.5) of hospitalized cases. Moreover, among hospitalized individuals, the diabetes prevalence 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) of decreased individuals.

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

Using a modified version of the comparative risk assessment model, investigators estimated the overall PAF of diabetes at 9.5% (95% CI, 7.3 – 11.7) for the presence of severe disease 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 PAF of diabetes contributing to COVID-19 disease burden.

“To the best of our knowledge, this is the first study to quantify the impact of diabetes on the adverse outcomes of COVID-19 at the global level,” investigators wrote. “This finding reinforces the fact that individuals living with diabetes are more likely to progress to severe complications when infected by SARS-CoV-2.”

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; Global Diabetes Prevalence in COVID-19 Patients and Contribution to COVID-19– Related Severity and Mortality: A Systematic Review and Meta-analysis. Diabetes Care 1 April 2023; 46 (4): 890–897. https://doi.org/10.2337/dc22-1943