Diabetes and COVID-19: Impact 18 Months into the Pandemic

Systemic review shows sex, age, comorbid conditions, insulin use, and several out-of-range lab predictors on hospital admission, all play a role in COVID-19 severity in people with diabetes.

As we approach almost two years into the COVID-19 pandemic, we investigate the impact diabetes has had on the pandemic and the patients that dealt with the more severe COVID-19 effects. There have been plenty of studies done that highlight the relationship between the COVID-19 pandemic and diabetes. These studies include Covid-19 And Diabetes: A Complex Bidirectional Relationship, How Covid-19 Impacts Diabetes, and many other studies. In addition, at least three prior studies have examined the association of previous levels of A1C management and the risk of poor outcomes in COVID-19 virus patients.

This study is a literature synthesis that discusses the predictors of severe adverse outcomes and implications of an overall pandemic on patients who contract the virus with pre-diagnosed diabetes—aimed at summarizing the relationship between diabetes and severe COVID-19 symptoms, morbidity, and mortality. This literature synthesis also addresses the need for epidemiological studies for the next phase of the pandemic. A comprehensive systemic review of 22 studies of predictors of COVID-19 severity and death found that male sex, age, several comorbid conditions, insulin use, and several out-of-range lab predictors on admission all played a role. One month after the first reported COVID-19 virus clusters, diabetes was a considerable risk factor and predictor of severe/poor outcomes. Once the case series expanded beyond China, the evidence that showed the significant role of diabetes in the severity of the COVID-19 pandemic grew.

Case series show that 30-40% of people with COVID-19 related hospitalization, severe morbidity requiring an intensive care stay, and death, had type 1 or 2 diabetes. Among those hospitalized individuals with diabetes, 21-43% required ICU stay, and fatality rates were about 25%. In addition, the case series showed that the risk of severe morbidity and mortality was 100-240% higher among those who had diabetes than patients without diabetes.

Potential pathways that increase morbidity and mortality in patients with diabetes include disruption of glucose metabolism, immune modulation, coagulation, and inflammatory response (accompanying obesity, CVD, renal disease, and exacerbation of acute hyperglycemia).

Indirect impacts of COVID-19 are one of the most profound effects since the pandemic started for some diabetes patients. Societal disruption has had adverse effects on detecting, monitoring, and managing diabetes and other conditions, impacting patients with diabetes’ ability to manage their diabetes and other comorbidities.

The large amounts of case series give us a reasonable implication of the impact of COVID-19 in the diabetic population. More studies that include population denominators (lifestyle during the pandemic, lockdown policies, etc.) are needed to understand the entire risk. Also, more studies showing the indirect effects of the pandemic will need to be done. 80% of individuals with diabetes reside in low-middle class countries. There has been little to no epidemiologic assessment of the role of diabetes, which leaves an uncertain and unclear picture of the magnitude of the COVID-19 pandemic and diabetes relationship.

Practice Pearls:

• Diabetes plays a significant role in the increase in morbidity and mortality for COVID-19 patients.
• 30-40% of severe cases and deaths were in diabetes patients, and there was a 100-250% increase in the risk of poor outcomes with a comorbid diagnosis of diabetes
• More studies need to be done excluding population denominators and including low-middle class patients with diabetes.

Diabetes and COVID-19: Population Impact 18 Months Into the Pandemic Edward W. Gregg, Marisa K. Sophiea, Misghina Weldegiorgis Diabetes Care Sep 2021, 44 (9) 1916-1923; DOI: 10.2337/dci21-0001 Diabetes and COVID-19: Population Impact 18 Months Into the Pandemic

Abdi A, Jalilian M, Sarbarzeh PA, Vlaisavljevic Z. Diabetes and COVID-19: A systematic review on the current evidences. Diabetes Res Clin Pract. 2020;166:108347. doi:10.1016/j.diabres.2020.108347

Erica Hicks, PharmD Candidate 2022, South College School of Pharmacy