Abstract
<p> </p> <p><strong>BACKGROUND: </strong>COVID-19 and diabetes both contribute to large global disease burdens.</p> <p><strong>PURPOSE:</strong> To quantify the prevalence of diabetes in various COVID-19 disease stages and calculate the population attributable fraction (PAF) of diabetes to COVID-19-related severity and mortality</p> <p><strong>DATA SOURCES</strong>: Systematic review identified 729 studies with 29,874,938 COVID-19 patients.</p> <p><strong>STUDY SELECTION</strong>: Studies detailed the prevalence of diabetes in subjects with known COVID-19 diagnosis and severity.</p> <p><strong>DATA EXTRACTION</strong>: Study information, COVID-19 disease stages and diabetes prevalence were extracted.</p> <p><strong>DATA SYNTHESIS</strong>: The pooled prevalence of diabetes in stratified COVID-19 groups was 14.7% (95%CI: 12.5–16.9) among confirmed cases, 10.4% (7.6–13.6) among non-hospitalized cases, 21.4% (20.4–22.5) among hospitalized cases, 11.9% (10.2–13.7) among non-severe cases, 28.9% (27.0–30.8) among severe cases and 34.6% (32.8–36.5) among deceased subjects, respectively. Multivariate meta-regression analysis explained 53–83% heterogeneity of the pooled prevalence. Based on a modified version of the comparative risk assessment model, we estimated that the overall PAF of diabetes was 9.5% (7.3–11.7) for the presence of severe disease in COVID-19 individuals and 16.8% (14.8–18.8) for COVID-19-related deaths. Subgroup analyses demonstrated that countries with high-income levels, high healthcare access and quality index (HAQ) and low diabetes disease burden had lower PAF of diabetes contributing to COVID-19 severity and death.</p> <p><strong>LIMITATIONS</strong>: Most studies had a high risk of bias.</p> <p><strong>CONCLUSIONS</strong>: The prevalence of diabetes increases with COVID-19 severity and diabetes accounts for 9.5% of severe COVID-19 cases and 16.8% of deaths, with disparities according to country income, HAQ, and diabetes disease burden.</p>
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