Diabetes was the second most prevalent comorbidity in a study conducted in Wuhan, China, comprised of 1,576 COVID-19-infected patients (9.7%, 95% CI 7.2-12.2%).

Diabetes in COVID-19 Patients in Wuhan, China

• The primary goal of study was to assess the relationship between obesity, type 2 diabetes, and hypertension with severe COVID-19, in Mexico.

• Data was collected from all over Mexico using the Mexican Institute of Epidemiological Diagnosis and Reference; 18,443 tested negative, 3,844 tested positive, and 1,306 were positive for other respiratory viruses.

• Positive cases were compared to negative cases and those who were positive for other respiratory illnesses.

• Patients who tested positive had a higher proportion of obesity (17.4%), diabetes (14.5%), and hypertension (18.9%).

• Patients with obesity had a 1.43-fold chance of developing severe COVID-19, patients with diabetes had a 1.87-fold chance of developing severe COVID-19, and patients with hypertension had a 1.77-fold chance of developing severe COVID‐19.

• Obesity, diabetes, and hypertension were all significantly related to severe COVID-19 development in comparison to patients without these preexisting conditions.

Diabetes in COVID-19 Patients in Mexico

• The primary objective of this study was to determine the relationship between pre-existing diabetes and in-hospital mortality of COVID-19 patients.

• This study was conducted in the Lombardy region of Italy and the data came from Policlinico di Monza hospital.

• 373 patients were assessed in this study. 

• The mean age of the patients was 72 years and 69 of the 373 patients had pre-existing diabetes.

• It was found that patients with pre-existing diabetes were more commonly associated with hypertension and chronic kidney disease when comparing them to non-diabetic patients.

• It was also found that diabetes was independently associated with an increased in-hospital mortality while hypertension and chronic kidney disease were not. 

• This study demonstrates that in the Lombardy region of Italy, patients with diabetes are at a higher risk of in-hospital mortality than non-diabetic patients.


Diabetes in COVID-19 Patients in Lombardy, Italy

• The objective of this study was to understand the association of COVID-19 related mortality and patients with type 1 or type 2 diabetes in England.

• The data for this study utilized national data and was provided by the National Diabetes Audit.

• The weekly number of deaths of patients with either form of diabetes was recorded for the first 19 weeks of 2020 and the percentage difference in mortality rate from previous years was calculated.

• It was found that 464 people with type 1 diabetes and 10,525 people with type 2 diabetes had COVID-19 related deaths in this 19-week period.

• It was calculated that the mortality rate for the first 19 weeks of 2020 was higher by 50.9% in people with type 1 diabetes and 64.3% in people with type 2 diabetes.

• The study concluded that mortality rates rose sharply in both patients of type 1 and type 2 diabetes during the COVID-19 pandemic in England. 

•This increased mortality was independently associated with diabetes.


Diabetes in COVID-19 Patients in England

- The objective of this study was to analyze comorbidities and associated mortality rates of COVID-19 patients in Saudi Arabia. 

- The data for this study was obtained from a King Salman Hospital in Riyadh, Saudi Arabia and involved 300 patients that were admitted from May 1 to July 31, 2020.

- The most frequent comorbidities were hypertension at 28%, type 2 diabetes mellitus at 45.7%, and most (99%) patients had pneumonia.

- An age of >50 was associated with a 3x greater mortality rate than patients under the age of 50.

- Congestive heart failure and acute kidney injury were also significantly associated with higher mortality.

- Overall, type 2 diabetes was highly prevalent and congestive heart failure and acute kidney injury were associated with mortality among COVID-19 patients in Saudi Arabia.


Diabetes in COVID-19 Patients in Riyadh, Saudi Arabia

- Wuhan, China
- Mexico
- Italy
- England
- Saudi Arabia

Ohio State University, Columbus

University of Michigan - Ann Arbor

Smith College

- Prevalence of pathophysiology, prognosis, and practical considerations
- Knowledge in progress
- The link between diabetes and ACE2
- Diabetes in COVID-19 patients by geographic location 
- Degree of Hyperglycemia on COVID-19 mortality
- Diabetes Medication on COVID-19 mortality
- COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology

Diabetes as a Comorbidity of COVID-19

Diabetes was considered a comorbidity during SARS-CoV-1. Similarly, having diabetes tripled the risk of hospitalization and quadrupled the risk of ICU admission during the Influenza A (H1N1) outbreak in 2009. During the 2012 outbreak of MERS-CoV, the mortality rate for patients with diabetes was a staggering 35%. Patients with diabetes who test positive for COVID-19 are more likely to experience severe disease. 

Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations

Diabetes in elderly patients is a factor in the high rates of mortality for COVID-19 victims. Patients with diabetes or hypertension have an increased risk of having a severe case of COVID-19 or needing an ICU admission immediately. Infection of SARS-CoV-2 in diabetic patients triggers higher stress conditions which can increase blood glucose levels and cause unusual glucose fluctuation. Many of the elderly patients in Wuhan with diabetes are hypoglycemic. 

COVID-19 and diabetes: Knowledge in progress


The Link Between Diabetes and ACE2

Diabetes in COVID-19 Patients by Geographic Location

- It was found that those with diabetes mellitus were at a higher risk of death if diagnosed with COVID-19
- The overall odds ratio of mortality in COVID-19 patients with diabetes mellitus came out to be 1.9
- 1.9 indicates that those with diabetes mellitus are at a 90% increased risk of dying due 
to COVID-19 compared to those without COVID-19
- The odds ratio for one patients came out to be 57.77, indicating that this patient is ~58 times more likely to die from COVID-19

Diabetes Mellitus and a study of its Epidemiology in relation to COVID-19

- Increased glucose levels negatively impact how the immune system responds when a virus is present
- Hyperglycemia is associated with how the lung functions
- IL-6 and D-dimer are elevated in those with hyperglycemia
- In fact, IL-6 plays a role in inflammation, which can negatively affect those with COVID-19

The effect of hyperglycemia in relation ot COVID-19

- Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID‐19
- Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration

Degree of Hyperglycemia on COVID-19 Mortality

- Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

Diabetes Medication on COVID-19 Mortality 

People with diabetes mellitus are among those with the highest risk of COVID-19 infection related complications as chronic hyperglycemia has a negative impact on immune function and increases the risk of morbidity and mortality with any infections. This was was evident with the H1N1 pandemic in which diabetes tripled the risk of ICU admissions when hospitalized. Around February 2020, diabetes accounted for 42.3% of major comorbidities in COVID-19 cases in Wuhan, China. A mortality of 7.3% was also reported for people with diabetes. Due to likeliness of people with diabetes to experience a deterioration of glycemic control when infected with COVID-19, it is essential for people with diabetes to contact their healthcare providers for advice an avoiding a loss of control over their diabetes.  

COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology

Campos Codo, A. Elevated Glucose Levels Favor SARS-CoV-2 Infection and Monocyte Response through a HIF-1α/Glycolysis-Dependent Axis https://pubmed.ncbi.nlm.nih.gov/32697943/. 

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