Association of Diabetes and Severe COVID-19 Outcomes: A Rapid Review and Meta-Analysis

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Background: Addressing the urgent need for evidence on diabetes as a serious comorbidity for severe illness and death from COVID-19, we investigated the association between diabetes and COVID-19 disease severity in patients hospitalised due to COVID-19.Methods: In this rapid review and meta-analysis, MEDLINE and EMBASE were searched for studies published between 01 January and 20 May 2020. Studies included were English-language, peer-reviewed, observational studies of adults hospitalised for COVID-19 with reported clinical course and living with or without diabetes. The severity of clinical course was assessed using a composite outcome (mortality, admittance to ICU, requirement for IMV, clinically defined severe or critical disease). Data and adjusted measures of association were extracted from published reports, and meta-analysis was performed using a random effects model. Registered with OSF (https://osf.io/agsyb/).Findings: A literature search yielded 431 articles, of which 45 studies (22,091 patients) met the inclusion criteria and 14 studies (12,383 patients) reported an adjusted measure of association for diabetes with the composite outcome with pooled hazard ratio 1·59 (95% confidence interval 1.3–1.93; I 2 =0%, p=0·820) and pooled odds ratio of 2·15 (95% confidence interval 1·63–2·83; I 2 =0%, p=0·892); evidence by GRADE was moderate.Interpretation: People living with diabetes are more likely to develop severe COVID-19 clinical course if hospitalised for COVID-19 than people not living with diabetes. To inform clinical decision-making during the pandemic, our findings support that people living with diabetes who are hospitalised for COVID-19 should be prioritised when triaged as at increased risk for the development of severe clinical course. Funding: Novo Nordisk A/SDeclaration of Interests: HM reports personal fees from Last Mile and, outside the submitted work, HM is part of the Evidence-Based Healthcare and Public Health in Africa (CEBHA+) Scholarship Programme. CEBHA+ receives funding from the Federal Ministry for Education and Research (Bundesministerium für Bildung und Forschung, BMBF), Germany. MK reports personal fees from Last Mile and, outside the submitted work, MK is part of the HIV-associated Tuberculosis Training Program Fogarty Fellowship supported by the National Institutes of Health. NM is employed by Last Mile P/S. Last Mile receives consultancy fees from Novo Nordisk. NH, UP, and CV are employed by Novo Nordisk. BC reports grants and personal fees from Amgen, Astra-Zeneca, Akcea, Genfit, Gilead, Eli Lilly, Novo Nordisk, and Merck (MSD), and grants and personal fees from Sanofi and Regeneron, outside the submitted work. MAR reports grants and personal fees from Novo Nordisk, and personal fees from AstraZeneca, Eli Lilly, Janssen, MSD, Mundipharma, and Sanofi. Ethics Approval Statement: No ethics approval was sought for this study as it is a meta-analysis ofpublished studies.