Impact of Diabetes on COVID-19 mortality and hospital outcomes, a global perspective: An umbrella systematic review and meta-analysis

Stavroula Kastora* (Corresponding Author), Manisha Patel,, Ben Carter, Mirela Delibegovic, Phyo Kyaw Myint

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

28 Citations (Scopus)
8 Downloads (Pure)


To date, COVID-19 has claimed 4.9 million lives. Diabetes has been identified as an
independent risk factor of serious outcomes in people with COVID-19 infection. Whether that holds true across world regions uniformly has not been previously assessed.
Research Design and Methods. This study offers the first umbrella systematic review and meta-analysis to analyse the collective and geographically stratified mortality, ICU admission, ventilation requirement, illness severity and discharge rate among patients with diabetes. Five databases (EMBASE,
MEDLINE, CAB Abstracts, PsychInfo, and Web of Science) and 3 additional sources (SSRN´s eLibrary, Research Square and MedRxiv) were searched from inception to 30th of August 2021. Prospective and retrospective cohort studies, reporting the association between diabetes and one or more COVID-19 hospitalization outcomes, were included. This meta-analysis was
registered on PROSPERO, CRD42021278579. Abbreviated MeSH terms used for search were: (Diabetes) AND (2019 Novel Coronavirus Disease), adapted per database requirements. Exclusion criteria exclusion criteria were 1) none of the primary or secondary outcomes of meta-analysis reported, 2) no confirmed COVID-19 infection (laboratory or clinical), 3) no unexposed population (solely patients with diabetes included). Quality of the included studies
were assessed using the Newcastle-Ottawa Scale (NOS) while quality of evidence by the GRADE framework. Studies that were clinically homogeneous were pooled. Summative data and heterogeneity were generated by the Cochrane platform RevMan (V. 5.4).
Original languageEnglish
Article numbere00338
Number of pages14
JournalEndocrinology, Diabetes & Metabolism
Issue number3
Early online date20 Apr 2022
Publication statusPublished - 1 May 2022

Bibliographical note

OA via Wiley agreement

Data Availability Statement

The data used and analysed during the current study are available as online Supplementary Material.


  • diabetes
  • covid 19
  • mortality
  • intensive care
  • ventilation
  • disease severity
  • discharge


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