Phenotypes Associated with Severe COVID-19 Similar Among Patients with and without Diabetes


A systematic review and meta-analysis of data from nearly 2 dozen studies is providing new insight into the phenotypes of patients with diabetes associated with worse outcomes from COVID-19.

Elderly patient with COVID-19 and diabetes

Data from a new study conducted by investigators at the Leibniz Center for Diabetes Research in Germany is providing clinicians with further insight into specific characteristics associated with worse COVID-19 outcomes in patients with diabetes.

A systematic review and meta-analysis of observational studies examining phenotypes of individuals with diabetes and COVID-19, the study’s results indicate associations with COVID-19 related death in people with diabetes were similar to those found among those without diabetes.

“Our living systemic review and meta-analysis provides the best current evidence on associations between phenotypes of individuals with diabetes and confirmed SARS-CoV-2 and COVID-19 related death and severity of COVID-19,” wrote investigators

The first edition of a living systematic review and meta-analysis, investigators from Europe designed the current study in an effort to determine what factors were associated with COVID-19 related death and increased severity of the disease in patients with type 1 or type 2 diabetes. With this in mind, investigators performed a search of the PubMed, Web of science, Epistemonikos, and COVID-19 Research Database and identified studies obtained from this search for inclusion in their analyses.

From these 4 databases, investigators identified a total of 4150 records for possible inclusion. After application of inclusion criteria and eliminating duplicate articles, investigators selected 22 publications for inclusion in their final analyses. These studies ranged in size from 29 patients to 9460, with the total population from all publications at 17,687.

In regard to study characteristics, 14 studies were conducted in Asia, 5 were conducted in North America, and 3 were conducted in Europe. Among the studies, 13 did not specify the type of diabetes, 5 only included individuals with type 2 diabetes, and 4 studies included both type 1 and type 2 diabetes. Investigators also noted risk of bias was classified as low in 6 studies, moderate in 8 studies, and high in 8 studies.

For the purpose of analysis, investigators planned to use a random effect meta-analysis to determine the summary relative risks (SRR) and to use the GRADE tool to evaluate the certainty of results.

Upon analysis, results suggested there was a high to moderate certainty of evidence for association between male sex ([SRR, 1.28; 95% CI, 1.02-.61], n=10 studies), being older than 65 years of age ([SRR, 3.49; 95% CI, 1.82-6.69], n=6 studies), pre-existing comorbidities ([cardiovascular disease: SRR, 1.56; 95% CI, 1.09-2.24], n=8 studies; [chronic kidney disease: SRR, 1.93; 95% CI, 1.28-2.90], n=6 studies; [chronic obstructive pulmonary disease: SRR, 1.40; 95% CI, 1.21-1.62], n=5 studies), diabetes treatment ([insulin use: 1.75; 95% CI, 1.01- 3.03], n=5 studies; [metformin use: 0.50; 95% CI, 0.28-0.90], n=4 studies) and increased blood glucose at admission (11 mmol/L or more: SRR, 8.60; 95% CI, 2.25-32.83], n=2 studies).

“Male sex, older age and some pre-existing conditions, as well as the use of insulin, most of which are potential indicators for a more progressive course of diabetes, were associated with increased risk of COVID-19 related death and severity in individuals with diabetes and SARS-CoV-2 infection, whereas metformin use was associated with a lower risk of death,” wrote investigators.

Investigators highlighted similar, but overall weaker and less precise associations were observed between his phenotypes of diabetes and severity of COVID-19.

This study, “Risk phenotypes of diabetes and association with COVID-19 severity and death: a living systematic review and meta-analysis,” was published in Diabetologia.

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