Zhang Jialing, Ma Yanfang, To Wing Lam, Chow Sen, To Tang Hiu, Wong Hoi Ki, Luo Jingyuan, Hoi Cheung Chun, Bian Zhaoxiang
Vincent V.C Woo Chinese Medicine Clinical Research Institute, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, People's Republic of China.
School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, People's Republic of China.
BMJ Open. 2025 Mar 27;15(3):e090986. doi: 10.1136/bmjopen-2024-090986.
SARS-CoV-2 poses significant challenges to people living with diabetes (PLWD). This systematic review aimed to explore the impact of COVID-19 on mortality, complications associated with diabetes and haematological parameters among PLWD.
Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched between 1 December 2019 and 14 January 2025.
Eligible studies included case-control and cohort studies involving PLWD categorised into two groups: those with confirmed SARS-CoV-2 infection and those without.
Meta-analyses estimated the odds ratios (ORs) and mean differences (MDs) of outcomes including mortality, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), acute kidney injury, hospitalisation length and haematological parameters. We pooled results using random-effects models and assessed study quality with the Newcastle-Ottawa Scale. A funnel plot was used to detect potential publication bias. The overall certainty of evidence was assessed using GRADE.
25 of 7266 unique studies were eligible, including 1 154674 PLWD (561 558 with COVID-19 and 593 116 without COVID-19). SARS-CoV-2 infection in PLWD was associated with significantly increased mortality (OR 2.52, 95% CI 1.45 to 4.36, I=99%), acute kidney injury (3.69, 95% CI 2.75 to 4.94, I=0%), random plasma glucose in subjects with type 1 diabetes (MD 20.38 mg/dL, 95% CI 7.39 to 33.36, I=0%), haemoglobin A1C in subjects with type 2 diabetes (0.21%, 95% CI 0.05 to 0.38, I=13%), creatinine (0.12 mg/dL, 95% CI 0.04 to 0.19, I=0%), C reactive protein (38.30 mg/L, 95% CI 4.79 to 71.82, I=82%) and D-dimer (1.52 µg/mL, 95% CI 0.73 to 2.31, I=0%). No significant differences were observed in the incidence of ICU admission and DKA, hospitalisation length, haemoglobin, leucocyte, lymphocyte, neutrophil to lymphocyte ratio, platelet, blood urea nitrogen, estimated glomerular filtration rate, procalcitonin, albumin, ferritin and bilirubin among PLWD with and without SARS-CoV-2 infection.
SARS-CoV-2 infection is associated with elevated risks of mortality and acute kidney injury and poor glycaemic control in PLWD, alongside increased levels of inflammatory and coagulation biomarkers. These findings underscore the urgent need for tailored clinical management strategies for PLWD with COVID-19.
CRD42023418039.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）给糖尿病患者（PLWD）带来了重大挑战。本系统评价旨在探讨2019冠状病毒病（COVID-19）对糖尿病患者死亡率、糖尿病相关并发症及血液学参数的影响。
采用推荐分级的评估、制定与评价（GRADE）方法进行系统评价和荟萃分析。
于2019年12月1日至2025年1月14日检索了EMBASE、MEDLINE、Cochrane对照试验中央注册库和拉丁美洲及加勒比卫生科学数据库（LILACS）。
纳入的研究包括病例对照研究和队列研究，研究对象为糖尿病患者，分为两组：确诊感染SARS-CoV-2的患者和未感染的患者。
荟萃分析估计了包括死亡率、重症监护病房（ICU）入院率、糖尿病酮症酸中毒（DKA）、急性肾损伤、住院时间和血液学参数等结局的比值比（OR）和平均差（MD）。我们使用随机效应模型汇总结果，并使用纽卡斯尔-渥太华量表评估研究质量。采用漏斗图检测潜在的发表偏倚。使用GRADE评估证据的总体确定性。
7266项独立研究中有25项符合纳入标准，共纳入1154674例糖尿病患者（561558例感染COVID-19，593116例未感染COVID-19）。糖尿病患者感染SARS-CoV-2与死亡率显著增加（OR 2.52，95%CI 1.45至4.36，I²=99%）、急性肾损伤（3.69，95%CI 2.75至4.94，I²=0%）、1型糖尿病患者随机血糖（MD 20.38mg/dL，95%CI 7.39至33.36，I²=0%）、2型糖尿病患者糖化血红蛋白（0.21%，95%CI 0.05至0.38，I²=13%）、肌酐（0.12mg/dL，95%CI 0.04至0.19，I²=0%）、C反应蛋白（38.30mg/L，95%CI 4.79至71.82，I²=82%）和D-二聚体（1.52μg/mL，95%CI 0.73至2.31，I²=0%）相关。在感染和未感染SARS-CoV-2的糖尿病患者中，ICU入院率、DKA发生率、住院时间、血红蛋白、白细胞、淋巴细胞、中性粒细胞与淋巴细胞比值、血小板、血尿素氮、估算肾小球滤过率、降钙素原、白蛋白、铁蛋白和胆红素方面未观察到显著差异。
SARS-CoV-2感染与糖尿病患者死亡率和急性肾损伤风险升高、血糖控制不佳以及炎症和凝血生物标志物水平升高相关。这些发现强调了针对感染COVID-19的糖尿病患者制定个性化临床管理策略的迫切需求。
CRD42023418039。
