{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T20:10:28Z","timestamp":1778011828749,"version":"3.51.4"},"reference-count":120,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["305906\/2024\u20100"],"award-info":[{"award-number":["305906\/2024\u20100"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2024\/20061\u20109"],"award-info":[{"award-number":["2024\/20061\u20109"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["88887.823904\/2023\u201000"],"award-info":[{"award-number":["88887.823904\/2023\u201000"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Coronavirus disease 2019 (COVID\u201019), caused by severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102), is more severe in people with diabetes mellitus due to immune dysfunction, exacerbated inflammation and increased risk of co\u2010morbidities and mortality. In this context, this study aims to analyse the epidemiological profile of hospitalized people with diabetes mellitus and COVID\u201019 in Brazil over 4\u2009years of the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The epidemiological analysis was conducted using data from the Open\u2010Data\u2010SUS (\n                      <jats:italic>Sistema \u00danico de Sa\u00fade<\/jats:italic>\n                      , Brazilian Unified Health System) platform (Brazilian Ministry of Health) covering the period from March 2020 to March 2024. Data were processed in Statistical Package for the Social Sciences software, with missing values imputed using XLSTAT. Variables included demographic profile, viral infection, co\u2010morbidities, clinical signs and symptoms, intensive care unit (ICU) admission and mechanical ventilation, and outcomes. Statistical analyses comprised bivariate and multivariable logistic regression with a 5% significance level, focusing on two primary comparisons: the risk of death and the likelihood of classification as diabetes mellitus. The study protocol was approved by the institutional ethics committee.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 2,078,062 people hospitalized with SARS\u2010CoV\u20102 in Brazil, 22.2% (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009461,647) had diabetes mellitus, with marked regional heterogeneity in both prevalence and mortality. Overall mortality was 32.9% (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009683,088). Diabetes mellitus was not only highly prevalent but also emerged as an independent risk factor for in\u2010hospital death, significantly increasing mortality odds (OR\u2009=\u20091.178; 95% confidence interval [95% CI]\u2009=\u20091.168\u20131.188), as well as higher likelihood of ICU admission (OR\u2009=\u20091.102; 95% CI\u2009=\u20091.093\u20131.112) and invasive mechanical ventilation (OR\u2009=\u20091.102; 95% CI\u2009=\u20091.087\u20131.118). Older age, female sex and self\u2010identification as Black, mixed\u2010race or Asian were also strongly associated with diabetes mellitus. The presence of co\u2010morbidities, such as cardiopathy (heart disease), kidney disease, obesity, liver disease, and neurological disorders further amplified the risk of poor outcomes. Regarding vaccination, most people were unvaccinated, and while COVID\u201019 vaccination showed a modest association with DM diagnosis, it consistently reduced the risk of death (OR\u2009=\u20090.588; 95% CI\u2009=\u20090.583\u20130.594). Conversely, nosocomial infection substantially increased mortality risk, despite presenting a divergent pattern in relation to diabetes mellitus in adjusted models. Clinical symptoms most strongly associated with death included dyspnoea, respiratory discomfort and peripheral oxygen saturation below 95%. Hospital management variables were decisive: ICU admission and ventilatory support, especially invasive mechanical ventilation (OR\u2009=\u200912.933; 95% CI\u2009=\u200912.752\u201313.115), markedly increased mortality. Overall, advanced age remained the strongest predictor, with individuals older than 85\u2009years experiencing more than a 30\u2010fold increased risk of death compared with younger groups (OR\u2009=\u200932.840; 95% CI\u2009=\u200930.840\u201334.969).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diabetes mellitus is an independent predictor of worse outcomes in hospitalized people with COVID\u201019 in Brazil. Mortality is strongly influenced by age, co\u2010morbidities and severity markers, while vaccination provides substantial protection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70349","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T19:10:24Z","timestamp":1778008224000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The burden of COVID\u201019 in hospitalized people with diabetes mellitus in Brazil: Insights from four years of the pandemic"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3804-280X","authenticated-orcid":false,"given":"Ta\u00eds Mendes","family":"Camargo","sequence":"first","affiliation":[{"name":"Laboratory of Molecular Biology and Genetics, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"Laboratory of Clinical and Molecular Microbiology, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"LunGuardian Research Group\u2014Epidemiology of Respiratory and Infectious Diseases, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8840-9358","authenticated-orcid":false,"given":"Bianca Aparecida","family":"Siqueira","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular Biology and Genetics, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"Laboratory of Clinical and Molecular Microbiology, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"LunGuardian Research Group\u2014Epidemiology of Respiratory and Infectious Diseases, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5494-2171","authenticated-orcid":false,"given":"Luiz Felipe Azevedo","family":"Marques","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular Biology and Genetics, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"Laboratory of Clinical and Molecular Microbiology, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"LunGuardian Research Group\u2014Epidemiology of Respiratory and Infectious Diseases, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9920-5058","authenticated-orcid":false,"given":"Lucas Silva","family":"Mello","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular Biology and Genetics, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"Laboratory of Clinical and Molecular Microbiology, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"LunGuardian Research Group\u2014Epidemiology of Respiratory and Infectious Diseases, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4955-4234","authenticated-orcid":false,"given":"Fernando Augusto Lima","family":"Marson","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular Biology and Genetics, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"Laboratory of Clinical and Molecular Microbiology, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"},{"name":"LunGuardian Research Group\u2014Epidemiology of Respiratory and Infectious Diseases, Postgraduate Program of Health Sciences, Postgraduate Program in Health Data Science S\u00e3o Francisco University (Universidade S\u00e3o Francisco\u2014USF)  Bragan\u00e7a Paulista S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"COVID\u201019 cases | WHO 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