The association between COVID-19 and type 1 diabetes mellitus: A systematic review

Background/Aim: Various reports of the occurrence of type 1 diabetes mellitus (T1DM) in patients with COVID-19 have been published, denoting an association between both diseases. Therefore, we conducted this systematic review to summarize the prevalence of T1DM in COVID-19 patients and to identify the clinical presentations and outcomes in this patient population.Materials and methodsUp to 10/27/2020, Medline, Embase, cochrane and google scholar databases were searched for original studies investigating the association between COVID-19 and T1DM. A manual search was conducted to identify missing studies. The quality of included studies was analyzed by the National Institute of Health (NIH) risk of bias tool. Outcomes included length of hospital stay, hospitalization, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), severe hypoglycemia, and death.ResultsFifteen studies were included in the qualitative analysis. Included studies reported data of both adult and pediatric patients. The prevalence of T1DM in COVID-19 patients ranged from 0.15% to 28.98%, while the rate of COVID-19 in patients with T1DM ranged from 0% to 16.67%. Dry cough, nausea, vomiting, fever and elevated blood glucose levels were the most commonly reported presentations. The investigated outcomes varied widely among studied populations.ConclusionsThe prevalence of T1DM in patients with COVID-19 ranged from 0.15% to 28.98%. The most common presentation of COVID-19 in patients with T1DM included fever, dry cough, nausea and vomiting, elevated blood glucose and diabetic ketoacidosis. The outcomes of COVID-19 in terms of length of hospital stay, hospitalization, ICU admission, DKA rate, and severe hypoglycemia were reported variably in included studies. Due to the heterogeneous study populations and the presence of many limitations, more studies are still warranted to reach a definitive conclusion.     

Awareness regarding COVID-19 and problems being faced by young adults with type 1 diabetes mellitus amid nationwide lockdown in India: A qualitative interview study

AimsTo assess the awareness about COVID-19 and the problems being faced by young adults with T1DM amid nationwide lockdown in India.MethodsA cross-sectional telephone-based qualitative interview study was conducted in young adults (aged 18–30 years) with T1DM amid lockdown. Following verbal consent, participants were asked 8 open-ended questions, 5 on awareness about COVID-19 and 3 catering to problems being faced concerning diet, physical activity and treatment amid lockdown. On average, 3 interviews were conducted per day with each lasting for 15?20 min. Interviews were recorded, transcribed and analyzed by qualitative content analysis.ResultsThirty-two participants were interviewed; after exclusion of two poorly recorded interviews, 30 were finally analyzed. Mean age of participants was 22.4 ± 4.0 years (M:F = 8:7). Only 30%, 40% and 53% of participants were aware of modes of transmission (respiratory droplets and fomites), cardinal symptoms (fever, cough and breathing difficulty) and means of prevention (staying indoors, social distancing and regular hand washing), respectively. Majority of participants were unaware of additional risks associated with COVID-19 in diabetes mellitus. Most participants could continue with their routine diet and prescribed treatment regime, however, 90% reported a reduction in physical activity and 72% experienced worsening of glycemic control amid lockdown.ConclusionsYoung adults with T1DM lack adequate awareness about COVID-19. Increasing awareness and imparting diabetes self-management education via digital/print media is needed.     

COVID-19 vaccination in patients with diabetes mellitus: Current concepts,uncertainties and challenges

Background and aimsTo summarize the available evidence on the use COVID-19 vaccines in patients with diabetes mellitus.MethodsWe performed a thorough literature search with regard to COVID-19 vaccines in patients with type 1 and type 2 diabetes mellitus.ResultsThe novel coronavirus disease (COVID-19) tends to portend a poor prognosis in patients with diabetes mellitus (DM). Primary prevention remains the mainstay for mitigating the risks associated with COVID-19 in patients with DM. A significant step in primary prevention is timely vaccination. Routine vaccination against pneumococcal pneumonia, influenza, and hepatitis B is recommended in patients with DM with good efficacy and reasonable safety profile. With clinical data supporting a robust neutralizing antibody response in COVID-19 patients with DM, vaccination in individuals with DM is justified. In fact, as the burden of the disease is borne by people with DM, COVID-19 vaccination should be prioritized in individuals with DM. Multiple unresolved issues with regard to preferred vaccine type, vaccine efficacy and durability, frequency of administration, vaccination in children (<18 years) and pregnant/lactating women however remain, and need to be addressed through future research.ConclusionsPatients with type 1 and type 2 diabetes mellitus are at a high risk of poor prognosis with COVID-19 and vaccination should be prioritized in them. However, many unresolved issues with regard to COVID-19 vaccination need to be addressed through future research.     

Impaired anti-SARS-CoV-2 antibody response in non-severe COVID-19 patients with diabetes mellitus: A preliminary report

Background and aimsPatients with diabetes mellitus (DM) often demonstrate impaired antibody response to influenza/hepatitis B vaccines. Hence, we compared anti-SARS-CoV-2 antibody response in non-severe COVID-19 patients with and without type 2 diabetes mellitus (T2DM).MethodsRecords of non-severe COVID-19 patients admitted at our institution between April 10, 2020 and May 20, 2020 were retrieved. Qualitative detection of total (IgG + IgM) anti-SARS-CoV-2 antibody was performed using electrochemiluminescence immunoassay in plasma samples collected at least 14 days post-polymerase chain reaction (PCR) confirmation of diagnosis.ResultsThirty-one non-severe COVID-19 patients were included. Nine patients (29%) had T2DM with mean HbA_1c at admission of 8.3 ± 1.0%. Anti-SARS-CoV-2 antibody was estimated at a median of 16 (14–17) days post-PCR confirmation of COVID-19 diagnosis. Only three patients (10%) were seronegative, and all had T2DM. Patients with T2DM were more likely to have non-detectable anti-SARS-CoV-2 antibodies than those without DM (p = 0.019).ConclusionsCOVID-19 patients with T2DM may not undergo seroconversion even after two weeks of diagnosis. Impaired seroconversion could theoretically increase the risk of reinfections in patients with DM. However, the finding requires validation in large-scale studies involving serial estimations of anti-SARS-CoV-2 antibodies in patients with and without DM.     

COVID-19 among people with diabetes mellitus in Saudi Arabia: Current situation and new perspectives

Background and aimThis review aims to report the current status of COVID-19 among people with diabetes, newly diagnosed diabetes, diabetic ketoacidosis, and programmatic efforts including vaccinations.MethodsWe conducted a literature search using PubMed, Google, and Scopus until July 15, 2021.ResultsIn Saudi Arabia, most studies have reported diabetes as one of the highly prevalent comorbidities among patients with COVID-19. Currently, there are limited studies from Saudi Arabia on the newly diagnosed diabetes and diabetic ketoacidosis caused by COVID-19. The Saudi ministry has taken several measures to control the impact of COVID-19 among people with diabetes, including comprehensive guidelines and prioritized vaccinations. During the COVID-19 pandemic, the use of telehealth services dramatically increased in diabetes clinics in Saudi Arabia.ConclusionsFocused and evidence-based interventions are essential to control the impact of COVID-19 among people with diabetes.     

Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus

Background and aimsPeople with diabetes have multiple psychosocial issues related to diabetes and its complications and this may be exacerbated during the COVID-19 pandemic.MethodsWe reviewed the psychological adaptative difficulties in people with diabetes especially during natural disasters including the prevailing COVID-19 pandemic.ResultsThere are significant concerns regarding worsening of glycemic control, unavailability of appropriate medicines, inaccessibility to health care or acquiring SARS- CoV-2 infection and subsequent poorer outcomes during the COVID-19 pandemic. Although there are some guidance documents for managing diabetes and associated complications during COVID-19 pandemic but very few address the psychological issues in people with diabetes. We discuss the psychological adaptive difficulties and an approach to address the psychosocial concerns in people with diabetes during the COVID-19 pandemic.ConclusionsPeople with diabetes have significant diabetes distress and psychological adaptive difficulties that is aggravated by the COVID-19 pandemic. An integrated multidisciplinary approach is needed to manage the prevailing psychological issues amongst people with diabetes during the COVID-19 pandemic.     

糖尿病不同降糖药物与新型冠状病毒肺炎的相关性研究进展

糖尿病是一种慢性代谢性疾病,其特征为多种代谢及血管异常,会影响机体对病原体的反应,大多数现有证据表明,无论是1型糖尿病(T1DM)还是2型糖尿病(T2DM)患者,新冠肺炎的严重程度和死亡率都有显著增加,新型冠状病毒肺炎(COVID-19)的存在也对糖尿病的治疗产生了一定的影响。本文对COVID-19及糖尿病的相互作用机...     

Relation of D-dimer levels of COVID-19 patients with diabetes mellitus

Background and aimsDiabetes is a frequent comorbidity in patients with Severe COVID-19 infection associated with a worse prognosis. Hypercoagulability with elevation in D-dimer levels has been demonstrated in patients with COVID-19. This study aims to study D-dimer levels in people with diabetes compared to those without diabetes among patients with COVID-19 infection.MethodsIn this observational study 98 moderate and severely ill patients with COVID-19 infection were included at a dedicated COVID hospital. The study group was divided into patients with diabetes and without diabetes. Peak D-dimer was measured in both the groups and compared using appropriate statistical tests.ResultsIn our study peak D-dimer levels were 1509 ± 2420 ng/mL (Mean ± SD) in people with diabetes and 515 ± 624 ng/mL (Mean ± SD) in patients without diabetes. Patients with diabetes had higher D-dimer levels which were statistically significant.ConclusionsThis study shows COVID-19 patients with diabetes had significantly higher D-dimer levels. Therefore, it is possible that COVID-19 infection with diabetes is more likely to cause hypercoagulable state with a worse prognosis. However clinical implications of these findings will need to be seen in further studies.     

老年糖尿病患者并发新型冠状病毒肺炎预后及其相关因素分析

目的分析老年糖尿病患者并发新型冠状病毒肺炎(COVID-19)的临床特征及其预后相关因素,为早期防治提供参考依据。 方法以2020年2月4日至2020年4月16日确诊的COVID-19 3 733例中伴有糖尿病的老年患者227例作为分析对象,采集患者一般资料、基础疾病、临床特征、实验室结果等信息,采用SPSS 23.0进行数据描述和分析。 结果227例老年糖尿病患者并发COVID-19被纳入分析,住院期间死亡16例,病死率为7.0%(16/227);单因素和多因素Logistic回归分析结果提示：肺部疾病、血糖、白细胞、中性粒细胞、肌酐、CKMB和呼吸困难是老年糖尿病并发COVID-19预后危险因素;采用这些因素预测老年糖尿病并发COVID-19死亡的ROC曲线下面积(AUC)为96.0%(95CI：91.0%~100.0%)。 结论老年人群中,糖尿病患者并发COVID-19的患者其预后风险较高,采用血糖和白细胞等因素预测COVID-19的预后具有临床意义。     

COVID-19 and diabetes mellitus: A need for prudence in elderly patients from a pooled analysis

ObjectiveThe objective of this study was to evaluate the pooled estimate of diabetes prevalence in young (<50 years) versus elderly (>50 years) COVID-19 cohorts.MethodsStudies published between December-2019 and March-2020 reporting demographic and clinical characteristics of COVID-19 cases were identified. A total of 11 studies included accounting for 2084 COVID-19 patients.ResultsThe overall prevalence of diabetes in COVID-19 patients with a mean age>50 years was 13.2%, whereas studies with relatively younger patients (mean age <50 years) had a pooled prevalence of 9.0%ConclusionThe overall prevalence of diabetes in COVID-19 patients was found to be 13.2% with studies including relatively elderly patients showing higher rates of diabetes. The intermingled effects of diabetes with other cardiovascular comorbidities warrant age-specific outcomes data including the impact of ongoing antidiabetic treatment.     

Vitamin D deficiency in patients with diabetes and COVID- 19 infection

Background and aimsData show that vitamin D deficiency may play a role in patients with diabetes mellitus and COVID-19 infection. In this article, we review evidence of vitamin D deficiency and COVID-19 infection in context of diabetes mellitus.MethodsA literature search was carried out by using the key term ‘COVID 19’ combined with ‘Diabetes’, ‘Vitamin D’, ‘Extra skeletal effects’, ‘immunity’, ‘infection’, ‘India’ from Pub Med (National Library of Medicine, Bethesda, MD and Google Scholar from December 2019 to May 2020. A manual search of the references was also carried out.ResultsVitamin D deficiency has been linked to increased morbidity and mortality in COVID -19 infections but convincing data on diabetic subgroup of patients in particular is still awaited.ConclusionRobust studies are required to ascertain if Vitamin D supplementation could be beneficial in patients with diabetes and COVID-19.     

Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq

Background and aimsThere is limited data about the prognosis and impact of COVID-19 pneumonia on patients with diabetes mellitus (DM). We aimed to assess blood indices, ECG markers of sudden death and malignant arrhythmias on admission, and diabetes lowering drugs as possible predictors of adverse in-hospital outcome and COVID-19 pneumonia recovery status.MethodsA retrospective study included patients with newly diagnosed COVID-19 pneumonia from August 20, to October 5, 2020.ResultsA total of 192 patients with COVID-19 pneumonia were included in the present study, of whom 67 patients had DM. Low lymphocytes % [0.4(0.1–0.9), P = .011] and QTc interval prolongation [0.4(0.1–0.8), P = .022] were associated with increased length of ICU stay. On the other hand, metformin use [0.3(0.2–4), P = .032] and DPP-4 inhibitors use [0.3(0.2–3), P = .040] were associated with decreased length of ICU stay. QTc interval prolongation [0.4(0.1–0.9), P = .017] was associated with increased length of hospital stay, while using metformin [0.4(0.2–3), P = .022] was associated with decreased length of hospital stay. Low lymphocytes % [0.5(0.4–1.6), P = .001], insulin use [0.4(0.3–5), P = .003], and old age [0.5(0.1–2.3), P = .025] were associated with extensive lung injury. The risk for in-hospital death was associated with high neutrophil% [1(1–1.4), P = .045], while metformin use was associated with decreased risk for in-hospital death [0.1(0.1–0.6), P = .025]. Insulin use [0.3(0.2–4), P = .013] was associated with partial recovery following acute COVID pneumonia.ConclusionsMetformin and DPP-4 inhibitors use were associated with favorable in-hospital outcomes, while insulin use was associated with extensive lung injury and post-acute COVID-19 pneumonia partial recovery.     

Effect of remote management on comprehensive management of diabetes mellitus during the COVID-19 epidemic

ObjectiveWe learned about the health condition of people with diabetes during the COVID-19 epidemic through a questionnaire survey. We conducted a randomized controlled study to confirm the effectiveness of remote management using the mobile phone WeChat app on comprehensive management of diabetes mellitus during the COVID-19 epidemic.MethodsWe distributed questionnaires that collected information on the health condition of people with diabetes during the COVID-19 epidemic through the WeChat app. We assigned 90 cases to the intervention group and 90 cases to the control group. The intervention group was managed remotely through the WeChat app, and the control group received traditional medical treatment. The blood glucose, blood pressure, body mass index (BMI), time in range (TIR) and incidence of hypoglycemia were compared after three months of follow-up.ResultsThe BMI and postprandial blood glucose (PBG) of the control group at 3 months was significantly higher than that at baseline (P < 0.001), and TIR decreased at 3 months (P < 0.05). There was no significant difference in blood pressure compared with baseline in the control group, while blood pressure decreased in the intervention group (P < 0.05). In the intervention group, fast blood glucose(FBG) and PBG decreased compared with their baseline values, and the TIR level increased, both of which were statistically significant (P < 0.001). The FBG, PBG, and TIR of the intervention group were better than those in the control group at 3 months (P < 0.05). There was no difference in the incidence of hypoglycemia between the two groups.ConclusionDuring the COVID-19 epidemic, diabetes treatment has been facing new challenges, and the traditional treatment mode is limited. Remote management can increase TIR without increasing the risk of hypoglycemia. Remote management can prevent weight gain and improve patients’ self-management and compliance during the COVID-19 epidemic.     

COVID-19 vaccination in pregnant and lactating diabetic women

AimTo discuss available information on the opportunity for pregnant women affected by diabetes/obesity to receive COVID-19 vaccine.Data synthesisPregnant women with SARS-CoV-2 (COVID-19) infection are at high risk for severe acute respiratory syndrome and adverse outcomes. Pregnant women with severe COVID-19 present increased rates of preterm delivery (<37 gestational weeks), cesarean delivery and neonatal admissions to the intensive care unit. Comorbidity such as diabetes (pregestational or gestational) or obesity further increased maternal and fetal complications. It is known that diabetic or obese patients with COVID-19 present an unfavorable course and a worse prognosis, with a direct association between worse outcome and suboptimal glycol-metabolic control or body mass index (BMI) levels. Critical COVID-19 infection prevention is important for both mother and fetus. Vaccination during pregnancy is a common practice. Vaccines against COVID-19 are distributed across the world with some population considered to have a priority. Since pregnant women are excluded from clinical trials very little information are available on safety and efficacy of COVD-19 vaccines during pregnancy. However, it is well known the concept of passive immunization of the newborn obtained with transplacental passage of protective antibodies into the fetal/neonatal circulation after maternal infection or vaccination. Moreover, it has been reported that COVID-19 vaccine-induced IgG pass to the neonates through breastmilk. Therefore, maternal vaccination can protect mother, fetus and baby.ConclusionsAfter an individual risk/benefit evaluation pregnant and lactating women should be counselled to receive COVID-19 vaccines.     

COVID-19 and diabetes: Analysis of the scientific production indexed in Scopus

Background and aimCOVID-19 has affected the world population, with a higher impact among at-risk groups, such as diabetic patients. This has led to an exponential increase in the number of studies related to the subject, although their bibliometric characteristics are unknown. This article aims to characterize the world scientific production on COVID-19 and diabetes indexed in Scopus.MethodsArticles on the subject were retrieved using a search strategy and bibliometric indicators of production, visibility, collaboration and impact were studied.ResultsThe total scientific production was 1956 documents, which have 35086 citations and an h-index of 67. Articles published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews (n = 127), as well as those by researchers from the United States (n = 498) predominated. Articles by Chinese authors (n = 314) had the highest impact according to the received citations (n = 21757). India, China and Spain are leading countries in terms of the research in which they participate. There is extensive international scientific collaboration led by China, the United States and Italy.ConclusionThe volume of publications on COVID-19 and diabetes and their scientific impact show the incentive that the study of these diseases represents for the scientific community worldwide.     

Factors influencing on development of COVID-19 pneumonia and association with oral anti-diabetic drugs in hospitalized patients with diabetes mellitus

BackgroundDiabetes mellitus (DM) increases mortality and morbidity in patients with coronavirus disease (COVID-19). In this study, it was aimed to assess factors influencing on COVID-19 pneumonia in hospitalized patients with diabetes and association with oral anti-diabetic drugs.Materials and methodsThis cross-sectional study included 432 patients with type 2 diabetes mellitus diagnosed with COVID-19. Data regarding clinical characteristics, demographic characteristics, intensive care unit (ICU) rate in patients admitted to ICU, laboratory results on day 1 and 7, thoracic computed tomography (CT) findings and oral anti-diabetic drugs used were extracted from medical records. In all patients, 75-days mortality was recorded. Data were assessed independently.ResultsThere was pneumonia in 386 (89.4%) of 432 patients with diabetes. The risk for pneumonia was markedly higher in patients on DPP-4 inhibitors; however, there was no significant among other oral anti-diabetic groups and subgroups. In addition, elevated CRP was linked to the increased risk for pneumonia. Only patients in the pneumonia group had SGLT-2 inhibitor use. During follow-up, 91 patients died. In Cox regression analysis, low Glasgow Coma Scale score, and increased lactate dehydrogenase levels were identified as significant independent risk factors for mortality.ConclusionThe study indicated that DPP-4 inhibitor used and elevated CRP level were associated with pneumonia development. Only patients in the pneumonia group had SGLT-2 inhibitor use. No oral anti-diabetics was found to be associated with COVID-19 related death.     

Diabetes Mellitus and COVID-19: Review Article

Background and aimsWe aim to cover most of the current evidence on the mutual effect of diabetes & COVID-19 infection on each other and the management of the COVID-19 patients with diabetes.MethodsWe utilized databases to review the current evidence related to diabetes mellitus and COVID-19.ResultsWe discussed the most recent evidence of diabetes milieus and COVID-19 regarding risk factors, management, complications, and telemedicine.ConclusionDiabetes mellitus is associated with a significant risk of complications, extended hospital stays, and mortality in COVID-19 infected patients.     

Gestational diabetes mellitus and COVID-19, clinical characteristics and review of the literature

There is a lack of information about the maternal-fetal outcomes in patients with gestational diabetes and concomitant COVID-19; and there is even less information about the outcomes of pregnant women with gestational diabetes and COVID-19. We present a case of a primigravidae of 20-year-old woman with gestational diabetes and COVID-19 and a review of the literature.     

The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis

BackgroundThe effect directly from the coronavirus disease 2019 (COVID-19) infection on health and fatality has received considerable attention, particularly among people with type 2 diabetes mellitus (T2DM). However, evidence on the indirect impact of disrupted healthcare services during the pandemic on people with T2DM is limited. This systematic review aims to assess the indirect impact of the pandemic on the metabolic management of T2DM people without a history of COVID-19 infection.MethodsPubMed, Web of Science, and Scopus were systematically searched for studies that compared diabetes-related health outcomes between pre-pandemic and during-pandemic periods in people with T2DM and without the COVID-19 infection and published from January 1, 2020, to July 13, 2022. A meta-analysis was performed to estimate the overall effect on the diabetes indicators, including hemoglobin A1c (HbA1c), lipid profiles, and weight control, with different effect models according to the heterogeneity.ResultsEleven observational studies were included in the final review. No significant changes in HbA1c levels [weighted mean difference (WMD), 0.06 (95% CI −0.12 to 0.24)] and body weight index (BMI) [0.15 (95% CI −0.24 to 0.53)] between the pre-pandemic and during-pandemic were found in the meta-analysis. Four studies reported lipid indicators; most reported insignificant changes in low-density lipoprotein (LDL, n = 2) and high-density lipoprotein (HDL, n = 3); two studies reported an increase in total cholesterol and triglyceride.ConclusionsThis review did not find significant changes in HbA1c and BMI among people with T2DM after data pooling, but a possible worsening in lipids parameters during the COVID-19 pandemic. There were limited data on long-term outcomes and healthcare utilization, which warrants further research.Systematic review registrationPROSPERO CRD42022360433.