The association of diabetes with COVID-19 disease severity: evidence from adjusted effect estimates
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LETTER TO THE EDITOR
The association of diabetes with COVID-19 disease severity: evidence from adjusted effect estimates Xuan Liang 1 & Jie Xu 1 & Wenwei Xiao 1 & Li Shi 1 & Haiyan Yang 1 Received: 5 August 2020 / Accepted: 4 November 2020 # Hellenic Endocrine Society 2020
To the Editor, Diabetes, which is one of the leading causes of mortality and morbidity worldwide with increasing prevalence, is a wellknown risk factor for various infections, post-infection complications, and increased mortality secondary to infections [1]. Diabetes has now been shown to be among the most common medical conditions in patients who develop coronavirus disease 2019 (COVID-19) [2] and has been associated with higher mortality in patients with this disease [3]. Zheng et al. reported that diabetes is associated with an almost fourfold greater risk for severe disease and death in patients with COVID-19 (odds ratio (OR) = 3.68, 95% confidence interval (CI) [2.68–5.03]; P < 0.001) [4]. However, although a significant association was observed between diabetes and disease severity (including severe and critical conditions and mortality) among COVID-19 patients based on the data of unadjusted effect estimates (hazard ratio (HR)) in the study by Cummings et al., this disappeared based on the data of the adjusted effect estimates [5], which suggest that several factors such as age, gender, and underlying diseases might modulate the relationship between diabetes and COVID-19 disease severity. Therefore, it was evident that the association between diabetes and severe COVID-19 disease needed to be investigated via a quantitative meta-analysis based on the data of adjusted effect estimates. A systematic literature search was conducted for studies published from January 1, 2020, to July 25, 2020, in the PubMed, Chinese National Knowledge Infrastructure (CNKI), and Web of Science databases. According to the indices of the various databases, we used the search terms “coronavirus disease 2019,” “2019-nCoV, SARS-CoV-2,” “COVID-19,” and “diabetes,” and “diabetes mellitus.” Only
* Haiyan Yang [email protected] 1
Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
articles reporting adjusted effect estimates (adjusted OR or HR) for diabetes and severity of disease in COVID-19 patients were considered eligible. There was no restriction on country or location. All calculations were carried out with Stata 11. 2 software. The pooled OR and pooled HR with their corresponding 95% CI were applied to evaluate the risk of severity in diabetic patients with COVID-19. The choice of the appropriate effects model was based on the analysis results, as follows: the fixed effect model was used if I2 was < 50% and the random-effects model was used if I 2 was ≥ 50% [6]. Sensitivity analysis was conducted to evaluate the robustness of the results. Publication bias among the included studies was assessed by employing Begg’s funnel plot and Egger’s test. A total of 1057 studies were identified using the search algorithm. Twent
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