{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:48:23Z","timestamp":1784958503827,"version":"3.55.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>We sought to explore the relevance of analyses that include critical laboratory parameters and drug treatment, clinical characteristics of diabetic patients who are infected with COVID-19, to the development of individualized treatment strategies for diabetic patients infected with COVID-19.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched Cochrane, Embase, FMRS, Pubmed, Springer, Web of Science databases for systematic reviews and meta-analyses to estimate the clinical characteristics and prognosis of confirmed covid-19 infections in patients with and without diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our meta-analysis included a total of 32 studies with 192,693 COVID-19 patients. Common comorbidities in the diabetic group were hypertension, cerebrovascular disease, chronic kidney disease and cardiovascular disease. We discovered that white blood cell count, neutrophil count, inflammatory marker levels, D-dimer, urea, precursor of the brain natriuretic peptide (Pro-BNP) increased and lymphocyte count, estimated glomerular filtration rate (eGFR), albumin decreased significantly in the diabetic group in laboratory test results. Compared with the non-diabetic group, the diabetic group had a higher incidence of complications in acute respiratory distress syndrome (ARDS), shock, acute heart injury, acute kidney injury and more regularly used oxygen therapy, invasive ventilation, non-invasive ventilation, continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO) treatment. Mortality and intensive care unit (ICU) hospitalization rates were highest in the diabetic group than in the non-diabetic group (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Diabetic patients hospitalized with COVID-19 have an increased risk of death, lower discharge rates, and higher ICU admission rates. Their presence of hypertension, cerebrovascular disease, chronic kidney disease (CKD), higher levels of inflammatory markers. Multiple complications are all predictors of poor outcomes in people with diabetes. Our findings will help identify elevated risk factors in diabetics, which will benefit early prediction.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1523139","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T05:25:10Z","timestamp":1738128310000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["The clinical features and outcomes of diabetes patients infected with COVID-19: a systematic review and meta-analysis comprising 192,693 patients"],"prefix":"10.3389","volume":"12","author":[{"given":"Kai","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-ting","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.2337\/dc20-0598","article-title":"Clinical characteristics and risk factors for mortality of COVID-19 patients with diabetes in Wuhan, China: a two-center","volume":"43","author":"Shi","year":"2020","journal-title":"Diabetes Care"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"108467","DOI":"10.1016\/j.diabres.2020.108467","article-title":"Clinical characteristics and outcome of hospitalized COVID-19 patients with diabetes: a single-center, retrospective study in Iran","volume":"169","author":"Akbariqomi","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/6666086","article-title":"Prevalence risk factors and outcomes associated with acute kidney injury in patients hospitalized for COVID-19: a comparative study between diabetic and nondiabetic patients","volume":"2021","author":"Khalili","year":"2021","journal-title":"J Diabetes Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the new York City area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"87","DOI":"10.5603\/EP.a2022.0008","article-title":"Higher rate of COVID-19 mortality in patients with type 1 than type 2 diabetes: a nationwide study","volume":"73","author":"Demirci","year":"2022","journal-title":"Endokrynol Pol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e06706","DOI":"10.1016\/j.heliyon.2021.e06706","article-title":"Clinical characteristics and outcomes of COVID-19 patients with diabetes mellitus in Kuwait","volume":"7","author":"Alshukry","year":"2021","journal-title":"Heliyon"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1111\/all.14238","article-title":"Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China","volume":"75","author":"Zhang","year":"2020","journal-title":"Allergy"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1515\/cclm-2020-0198","article-title":"Laboratory abnormalities in patients with COVID-2019 infection","volume":"58","author":"Lippi","year":"2020","journal-title":"Clin Chem Lab Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"ref11","volume-title":"The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses","author":"Wells","year":"2020"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e3319","DOI":"10.1002\/dmrr.3319","article-title":"Diabetes is a risk factor for the progression and prognosis of COVID-19","volume":"36","author":"Guo","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"108217","DOI":"10.1016\/j.diabres.2020.108217","article-title":"The contribution of diabetic micro-angiopathy to adverse outcomes in COVID-19","volume":"164","author":"Whyte","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3126\/ajms.v12i9.38808","article-title":"Menopause and COVID19 severity: the missing link","volume":"12","author":"Ruby","year":"2021","journal-title":"Asian J Med Sci"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.biocel.2015.08.012","article-title":"Estrogen receptor signal in regulation of B cell activation during diverse immune responses","volume":"68","author":"Josaine","year":"2015","journal-title":"Int J Biochem Cell Biol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2001227","DOI":"10.1183\/13993003.01227-2020","article-title":"Cardiovascular comorbidity and its impact on patients with COVID-19","volume":"55","author":"Guan","year":"2020","journal-title":"Eur Respir J"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1111\/dme.14300","article-title":"COVID-19 and diabetes","volume":"37","author":"Ma","year":"2020","journal-title":"Diabet Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"E736","DOI":"10.1152\/ajpendo.00124.2020","article-title":"COVID-19 pandemic, coronaviruses, and diabetes mellitus","volume":"318","author":"Muniyappa","year":"2020","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.cmet.2020.07.007","article-title":"Elevated glucose levels favor SARS-CoV-2 infection and monocyte response through a HIF-1a\/glycolysis-dependent Axis","volume":"32","author":"Codo","year":"2020","journal-title":"Cell Metab"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.diabet.2020.05.005","article-title":"Negative impact of hyperglycaemia on tocilizumab therapy in Covid-19 patients","volume":"46","author":"Marfella","year":"2020","journal-title":"Diabetes Metab"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1136\/postgradmedj-2020-138756","article-title":"Is HbA1c an ideal biomarker of well-controlled diabetes?","volume":"97","author":"Kaiafa","year":"2021","journal-title":"Postgrad Med J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1198\/016214501753382273","article-title":"Variable selection via nonconcave penalized likelihood and its oracle properties","volume":"96","author":"Fan","year":"2001","journal-title":"J Am Stat Assoc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1161\/CIRCULATIONAHA.120.047430","article-title":"Pulmonary embolism in patients with COVID-19: awareness of an increased prevalence","volume":"142","author":"Poissy","year":"2020","journal-title":"Circulation"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2431","DOI":"10.1056\/NEJMoa2006923","article-title":"Renin-angiotensin-aldosterone system blockers and the risk of Covid-19","volume":"382","author":"Mancia","year":"2020","journal-title":"N Engl J Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s11883-020-00880-6","article-title":"Effect of renin-angiotensin-aldosterone system inhibitors in patients with COVID-19: a systematic review and Meta-analysis of 28,872 patients","volume":"22","author":"Baral","year":"2020","journal-title":"Curr Atheroscler Rep"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s12933-020-01184-4","article-title":"Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-Centre retrospective study","volume":"19","author":"Alguwaihes","year":"2020","journal-title":"Cardiovasc Diabetol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"154845","DOI":"10.1016\/j.metabol.2021.154845","article-title":"Thromboembolism risk among patients with diabetes\/stress hyperglycemia and COVID-19","volume":"123","author":"Calvisi","year":"2021","journal-title":"Metabolism"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"107809","DOI":"10.1016\/j.jdiacomp.2020.107809","article-title":"Hyperglycemia associated with lymphopenia and disease severity of COVID-19 in type 2 diabetes mellitus","volume":"35","author":"Cheng","year":"2021","journal-title":"J Diabetes Complicat"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e001343","DOI":"10.1136\/bmjdrc-2020-001343","article-title":"Clinical characteristics and outcomes of patients with severe covid-19 with diabetes","volume":"8","author":"Yan","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1111\/dom.14086","article-title":"The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: a single-Centre, retrospective, observational study in Wuhan","volume":"22","author":"Zhang","year":"2020","journal-title":"Diabetes Obes Metab"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"800","DOI":"10.3803\/EnM.2021.1040","article-title":"High Fibrosis-4 index is related with worse clinical outcome in patients with coronavirus disease 2019 and diabetes mellitus: a multicenter observational study","volume":"36","author":"Kim","year":"2021","journal-title":"Endocrinol Metab"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"108437","DOI":"10.1016\/j.diabres.2020.108437","article-title":"Fasting blood glucose level is a predictor of mortality in patients with COVID-19 independent of diabetes history","volume":"169","author":"Cai","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.2337\/dc20-0660","article-title":"Clinical characteristics and outcomes of patients with diabetes and COVID-19 in association with glucose-lowering medication","volume":"43","author":"Chen","year":"2020","journal-title":"Diabetes Care"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"692","DOI":"10.2337\/dc21-2102","article-title":"Inflammation, hyperglycemia, and adverse outcomes in individuals with diabetes mellitus hospitalized for COVID-19","volume":"45","author":"Vasbinder","year":"2022","journal-title":"Diabetes Care"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"170","DOI":"10.15537\/smj.2021.2.25700","article-title":"Diabetes mellitus as a comorbidity in COVID-19 infection in the United Arab Emirates","volume":"42","author":"Elemam","year":"2021","journal-title":"Saudi Med J"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"119371","DOI":"10.1016\/j.lfs.2021.119371","article-title":"Effects of metformin, insulin on COVID-19 patients with pre-existed type 2 diabetes: a multicentral retrospective study","volume":"275","author":"Cheng","year":"2021","journal-title":"Life Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"525","DOI":"10.3389\/fendo.2020.00525","article-title":"Impaired fasting glucose and diabetes are related to higher risks of complications and mortality among patients with coronavirus disease 2019","volume":"11","author":"Zhang","year":"2020","journal-title":"Front Endocrinol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/1753-0407.13121","article-title":"Elevated fasting blood glucose within the first week of hospitalization was associated with progression to severe illness of COVID-19 in patients with preexisting diabetes: a multicenter observational study","volume":"13","author":"Ling","year":"2021","journal-title":"J Diabetes"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"602","DOI":"10.4093\/dmj.2020.0146","article-title":"The clinical characteristics and outcomes of patients with moderate-to-severe coronavirus disease 2019 infection and diabetes in Daegu, South Korea","volume":"44","author":"Kim","year":"2020","journal-title":"Diabetes Metab J"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"596518","DOI":"10.3389\/fendo.2021.596518","article-title":"Immunological characteristics in type 2 diabetes mellitus among COVID-19 patients","volume":"12","author":"Han","year":"2021","journal-title":"Front Endocrinol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/1652403","article-title":"Clinical characteristics of diabetic patients with COVID-19","volume":"2020","author":"Li","year":"2020","journal-title":"J Diabetes Res"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"901","DOI":"10.3803\/EnM.2020.787","article-title":"Clinical outcomes of COVID-19 patients with type 2 diabetes: a population-based study in Korea","volume":"35","author":"You","year":"2020","journal-title":"Endocrinol Metab"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1111\/jch.14146","article-title":"Independent and combined effects of hypertension and diabetes on clinical outcomes in patients with COVID-19: a retrospective cohort study of Huoshen Mountain hospital and Guanggu Fangcang shelter hospital","volume":"23","author":"Sun","year":"2021","journal-title":"J Clin Hypertens"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"642452","DOI":"10.3389\/fendo.2021.642452","article-title":"Association between the concentration and Rangeability of cystatin C and mortality of COVID-19 patients with or without type 2 diabetes mellitus: a retrospective analysis","volume":"12","author":"Yang","year":"2021","journal-title":"Front Endocrinol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1016\/j.eng.2020.05.017","article-title":"Clinical characteristics and outcomes of type 2 diabetes patients infected with COVID-19: a retrospective study","volume":"6","author":"Chen","year":"2020","journal-title":"Engineering"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"101222","DOI":"10.1016\/j.diabet.2020.101222","article-title":"Association of diabetes and outcomes in patients with COVID-19: propensity score-matched analyses from a French retrospective cohort","volume":"47","author":"Sutter","year":"2021","journal-title":"Diabetes Metab"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1177\/1932296820924469","article-title":"Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States","volume":"14","author":"Bode","year":"2020","journal-title":"J Diabetes Sci Technol"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e3388","DOI":"10.1002\/dmrr.3388","article-title":"Characteristics and outcomes of COVID-19 in hospitalized patients with and without diabetes","volume":"37","author":"al-Salameh","year":"2021","journal-title":"Diabetes Metab Res Rev"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.17179\/excli2020-2988","article-title":"Clinical characteristics and outcomes of diabetics hospitalized for COVID-19 infection: a single-centered, retrospective, observational study","volume":"19","author":"Mansour","year":"2020","journal-title":"EXCLI J"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"405","DOI":"10.4093\/dmj.2020.0105","article-title":"The risk of diabetes on clinical outcomes in patients with coronavirus disease 2019: a retrospective cohort study","volume":"44","author":"Chung","year":"2020","journal-title":"Diabetes Metab J"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/dom.14604","article-title":"Glycated haemoglobin levels among 3295 hospitalized COVID-19 patients, with and without diabetes, and risk of severe infection, admission to an intensive care unit and all-cause mortality","volume":"24","author":"Alhakak","year":"2022","journal-title":"Diabetes Obes Metab"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1111\/1753-0407.13171","article-title":"Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: a nationwide study (TurCoviDia)","volume":"13","author":"Sonmez","year":"2021","journal-title":"J Diabetes"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1523139\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T05:25:19Z","timestamp":1738128319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1523139\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":52,"alternative-id":["10.3389\/fmed.2025.1523139"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1523139","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]},"article-number":"1523139"}}