Overview of adult COVID-19 clinical cohorts
| Study . | Location . | Participants (n) . | Diabetes findings . | Comorbidities findings* . | Select laboratory findings** . |
|---|---|---|---|---|---|
| Wang et al. (12) | Wuhan, China | 138 | Patients with diabetes constituted 22.2% of ICU patients vs. 5.9% of non-ICU patients, P = 0.009 | CVD, hypertension, cerebrovascular disease predisposed to ICU | Elevated WBC, neutrophils, ALT, AST, CK-MB, Cr, d-dimer, hs-TnI, LDH, PCT, and lymphopenia in ICU vs. non-ICU patients |
| Zhou et al. (13) | Wuhan, China | 191 | Patients with diabetes constituted 31% of nonsurvivors vs. 14% of survivors (P = 0.0051); OR 2.85 (95% CI 1.35–6.05; P = 0.0062) for in-hospital death in a univariate model | CVD, 24% nonsurvivors vs. 1% survivors (P < 0.0001), OR 21.40 (95% CI 4.64–98.76; P < 0.0001) in univariate model; hypertension, 48% nonsurvivors vs. 23% survivors (P = 0.0008), OR 3.05 (95% CI 1.57–5.92; P = 0.0010) in univariate model | Elevated WBC, ALT, CK, Cr, d-dimer, ferritin, hs-TnI, IL-6, LDH, PT, and PCT had significant HR >1 for death in univariate model; d-dimer had significant HR >1 for death in multivariate model |
| Guan et al. (14) | China | 1,099 | 16.2% of patients with severe vs. 5.7% with nonsevere COVID-19 infections had diabetes, and 26.9% that met vs. 6.1% that did not meet the primary composite end point (ICU, mechanical ventilation use, death) had diabetes; no P values | 5.8% of severe vs. 1.8% of nonsevere COVID-19 patients had CHD, and 9.0% that met vs. 2.0% that did not meet the primary composite end point had CHD; 23.7% of severe vs. 13.4% of nonsevere COVID-19 patients had hypertension, and 35.8% that met vs. 13.7% that did not meet the primary composite end point had hypertension; no P values | Elevated WBC, ALT, AST, CRP, d-dimer, LDH, PCT, and lymphopenia in severe vs. nonsevere infection and in patients that met vs. did not meet the primary composite end point, no P values |
| Wu and McGoogan (15) | China | 72,314 total, 44,672 confirmed (factored into CFR) | CFR 7.3% in patients with diabetes vs. 2.3% for the entire cohort | CFR 10.5% for CVD, 6.0% for hypertension | Not examined |
| Richardson et al. (17) | NYC area | 5,700 | Diabetes one of three most common morbidities. Patients with diabetes more likely to need mechanical ventilation or ICU | Hypertension and obesity two of three most common morbidities. Hypertensive patients less likely to need mechanical ventilation or ICU; 88% of COVID-19 patients had two or more comorbidities compared with one (6.3%) or none (6.1%). | Elevated ALT, AST, BNP, CRP, d-dimer, ferritin, LDH, PCT, and lymphopenia in hospitalized COVID-19 patients |
| Goyal et al. (18) | NYC | 393 | Diabetes was more frequent in patients requiring mechanical ventilation (27.7%) vs. not (24.0%) (P value not stated) | Hypertension, CAD, and obesity were more frequent in patients requiring mechanical ventilation (P values not stated) | Majority of patients had lymphopenia (90.0%), thrombocytopenia (27%); many had elevated liver function values and inflammatory markers (CRP, d-dimer, ferritin, PCT), which were further increased in patients requiring mechanical ventilation |
| Cummings et al. (5) | NYC | 1,150 | Diabetes one of three most common morbidities. Univariate HR 1.65 (95% CI 1.11–2.44), not significant in multivariate HR 1.31 (95% CI 0.81–2.10) for in-hospital mortality | Hypertension and obesity two of three most common morbidities. Hypertension univariate HR 2.24 (95% CI 1.40–3.59); CCD univariate HR 2.21 (95% CI 1.44–3.39), multivariate HR 1.76 (95% CI 1.08–2.86); BMI ≥40 kg/m2 not significant univariate HR 0.76 (95% CI 0.40–1.47) for in-hospital mortality; CKD was not a risk for in-hospital death | Aside from other altered markers, IL-6 univariate HR 1.12 (95% CI 1.04–1.21) and multivariate HR 1.11 (95% CI 1.02–1.20) and d-dimer univariate HR 1.18 (95% CI 1.10–1.27) and multivariate HR 1.10 (95% CI 1.01–1.19) for in-hospital mortality |
| Suleyman et al. (19) | Detroit, MI | 463 | Diabetes was more frequent in hospitalized (43.4%) vs. discharged (20.4%) patients (P < 0.001). It was also more frequent in ICU (51.8%) vs. non-ICU (38.8%) patients (P = 0.02) but was not a risk in multivariate analysis for ICU or mechanical ventilation. African American race was not more frequent in admitted or ICU vs. discharged patients or a risk for mechanical ventilation or death | Hypertension, CVD, obesity, and CKD were more frequent in hospitalized vs. discharged patients. Hypertension and CKD were also more frequent in ICU vs. non-ICU patients. CKD and severe obesity were risks in multivariate analysis for ICU or mechanical ventilation | Elevated AST, Cr, and hs-TnI; lower WBC; and lymphopenia in hospitalized vs. discharged patients by univariate analysis. Elevated WBC, AST, Cr, d-dimer, ferritin, hs-TnI, LDH, PCT, and lymphopenia in ICU vs. non-ICU patients by univariate analysis |
| Petrilli et al. (20) | NYC | 5,279 | Diabetes had multivariate OR 2.24 (95% CI 1.84–2.73; P < 0.001) for hospital admission, with adjustment for patient characteristics, comorbidities | All multivariate: heart failure OR 4.43 (95% CI 2.59–8.04; P < 0.001), hypertension OR 1.78 (95% CI 1.49–2.12; P < 0.001), CKD OR 2.6 (95% CI 1.89–3.61; P < 0.001), hyperlipidemia OR 0.62 (95% CI 0.52–0.74; P < 0.001), BMI 25.0–29.9 kg/m2 (overweight) OR 1.3 (95% CI 1.07–1.57; P = 0.007), BMI 30–39.9 kg/m2 (obese class I and II) OR 1.8 (95% CI 1.47–2.2; P < 0.001), BMI ≥40 kg/m2 (obese class III) OR 2.45 (95% CI 1.78–3.36; P < 0.001); all for hospital admission, adjusted for same variables as diabetes | Elevated Cr, CRP, d-dimer, PCT, troponin, and lymphopenia in critical COVID-19 |
| Dreher et al. (21) | Aachen, Germany | 50 | Diabetes did not raise the risk for ARDS; no P values | Obesity, but not hypertension, raised the risk for ARDS; no P values | Elevated WBC, CK, CRP, d-dimer, IL-6, LDH, and PCT; no P values |
| Wu et al. (22) | Wuhan, China | 201 | Diabetes was more frequent in ARDS (19.0%) than non-ARDS (5.1%) patients (P = 0.002); risk for ARDS (HR 2.34 [95% CI 1.35–4.05]; P = 0.002) but not death (HR 1.58 [95% CI 0.80–3.13]; P = 0.19) | Hypertension was more frequent in ARDS (27.4%) than non-ARDS (13.7%) patients (P = 0.02), risk for ARDS (HR 1.82 [95% CI 1.13–2.95]; P = 0.01) but not death (HR 1.70 [95% CI 0.92–3.14]; P = 0.09) | Elevated neutrophils, AST, CRP, d-dimer, ferritin, LDH, and PT had significant HR >1 for ARDS; neutrophils, d-dimer, IL-6, and LDH had significant HR >1 for death |
| Galloway et al. (23) | U.K. | 1,157 | Diabetes had HR (adjustment for sex, age) of 1.42 for critical care (95% CI 1.04–1.95; P = 0.029) | Hypertension had HR (adjusted for sex, age) of 1.53 for critical care or death (95% CI 1.24–1.90; P = 0.000) | Neutrophils, Cr, and CRP had significant HR >1 for critical care or death |
| Liang et al. (24) | China | 1,590, discovery cohort; 710, validation cohort; risk score for critical illness | 6.8% noncritical vs. 23.7% critical disease among patients with diabetes | 3.2% noncritical vs. 9.9% critical disease among CVD patients; 14.8% noncritical vs. 40.5% critical disease among hypertension patients. Number of comorbidities had OR 1.60 (95% CI 1.27–2.00; P < 0.001) in multivariate analysis | Aside from other altered markers, neutrophil-to-lymphocyte ratio (OR 1.06 [95% CI 1.02–1.10]; P = 0.003) and LDH (OR 1.002 [95% CI 1.001–1.004]; P < 0.001) integrated into a 10-point risk score for critical illness |
| Cariou et al. (25) | France | 1,317, of whom 1,166 with T2D | Diabetes type, HbA1c, glucose-lowering therapy use did not affect primary outcome (mechanical ventilation and/or death within 7 days of admission) in univariate analysis | Micro- (OR 2.14 [95% CI 1.16–3.94]; P = 0.0153) and macrovascular (OR 2.54 [95% CI 1.44–4.50]; P = 0.0013) complications independently associated with 7-day mortality; BMI multivariate OR 1.28 (95% CI 1.10–1.47), P < 0.0010 for composite | AST (OR 2.23 [95% CI 1.70–2.93]; P < 0.0001) and CRP (OR 1.93 [95% CI 1.43–2.59]; P < 0.0001) independently associated with primary outcome; higher lymphocytes were protective (OR 0.67 [95% CI 0.50–0.88]; P = 0.0050) |
| Barron et al. (26) | U.K. | 23,698 COVID-19 deaths, 364 T1D COVID-19 deaths, 7,434 T2D COVID-19 deaths | T1D OR 2.86 (95% CI 2.58–3.18; P < 0.001) and T2D OR 1.80 (95% CI 1.75–1.86; P < 0.001) for death, with adjustment for age, sex, deprivation, ethnicity, CVD, cerebrovascular disease | CVD and cerebrovascular disease more frequent in T1D and T2D vs. nondiabetes in COVID-19 deaths | Not examined |
| Zhang et al. (27) | Wuhan, China | 258, of whom 63 with diabetes | Diabetes had multivariate HR 3.64 (95% CI 1.09–12.21; P = 0.036); elevated FBG (>7.54 mmol) had multivariate HR 1.19 (95% CI 1.08–1.31; P < 0.001); both for death adjusted for age, CVD, CKD, inflammatory markers | CVD more frequent in patients with diabetes (23.8%) vs. patients without diabetes (12.3%), P = 0.027; CKD more frequent in patients with diabetes (8.8%) vs. patients without patients (2.1%), P = 0.027 | Elevated WBC, neutrophils, CK-MB, d-dimer, TT in patients with diabetes vs. patients without diabetes |
| Guo et al. (28) | Wuhan, China | 174, overall analysis; 50, subgroup analysis | Patients with diabetes without any other comorbidities (16.5%) died more often than patients without diabetes without comorbidities (0%) (P = 0.03); however, the latter patients were younger | CVD was more prevalent in patients with diabetes, P = 0.013 | Elevated neutrophils, d-dimer, and ESR, and lymphopenia in patients with diabetes vs. patients without diabetes; neutrophils, ALT, CRP, d-dimer, ESR, ferritin, IL-6, LDH, and lymphopenia in patients with diabetes vs. patients without diabetes without comorbidities; however, the latter patients were younger |
| Zhu et al. (3) | Hubei Province, China | 7,337, of whom 952 with T2D | T2D patients had higher mortality: 7.8% vs. 2.7% overall, adjusted HR 1.49 (95% CI 1.13–1.96; P = 0.005); well-controlled blood glucose confers lower all-cause mortality, adjusted HR 0.14 (95% CI 0.03–0.60; P = 0.008) | Blood glucose correlated with comorbid CHD, hypertension | T2D patients had elevated WBC, neutrophils, Cr, CRP, d-dimer, IL-6, LDH, PCT, and lymphopenia vs. patients without diabetes; T2D patients with well-controlled vs. poorly controlled blood glucose had significantly fewer incidences of elevated WBC, neutrophils, ALT, AST, Cr, CRP, d-dimer, PCT, and lymphopenia; no P values |
| Iacobellis et al. (29) | Miami, FL | 85 | Admission hyperglycemia best predicted poor chest radiological outcomes | BMI correlated with poor chest radiological outcomes | Not examined |
| Li et al. (30) | Wuhan, China | 132, of whom 130 with T2D | Patients with diabetes stratified by admission glucose: group 1 (≤11 mmol/L) vs. group 2 (>11 mmol/L); group 2 had longer diabetes duration, more likely to suffer ACI, ICU admission, death | No difference in comorbidities in group 1 vs. group 2 | Elevated WBC, CRP, d-dimer, ESR, IL-6, and lymphopenia in group 2 vs. group 1; WBC (>109/L), Cr (<57/0 µmol/L), d-dimer (≥1.5 µg/L), hs-TnI (>26.2 pg/mL), LDH (>245 units/L), PCT univariate OR >1 for in-hospital complications |
| Chao et al. (31) | Taiwan | 452 | High glucose variability within the first day of ICU admission correlated with 30-day mortality, particularly in patients without diabetes. High glucose variability was more frequent in patients with diabetes | Except for diabetes, no difference in other comorbidities (e.g., CKD, CHD, cerebrovascular disease) in patients with high vs. low glucose variability; APACHE II score independently correlated with higher 30-day mortality | No differences in Cr, CRP, and PCT in patients with high vs. low glucose variability |
| Bode et al. (32) | U.S. | 1,122 | Diabetes and/or uncontrolled hyperglycemia increased hospital length of stay and mortality | Kidney function, as assessed by eGFR, was lower in patients with diabetes and/or uncontrolled hyperglycemia at admission | Elevated Cr in patients with diabetes and/or uncontrolled hyperglycemia vs. patients without diabetes or with controlled blood glucose patients |
| Williamson et al. (4) | U.K. | 10,926 COVID-19 deaths vs. 17,278,392 control subjects | Diabetes with HbA1c <7.5% (58 mmol/mol), HR 1.31 (95% CI 1.24–1.37), and with HbA1c ≥7.5% (58 mmol/mol), HR 1.95 (95% CI 1.83–2.07), for death, adjusted for age, sex, comorbidities, smoking, socioeconomic status. Mixed race, HR 1.43 (95% CI 1.11–1.85); South Asian, HR 1.44 (95% CI 1.32–1.58); and Black, HR 1.48 (95% CI 1.30–1.69); risks for death after adjustment for the same variables | BMI 30–34.9 kg/m2 (obese class I) nonsignificant HR 1.05 (95% CI 1.00–1.11), BMI 35–39.9 kg/m2 (obese class II) HR 1.40 (95% CI 1.30–1.52), BMI ≥40 kg/m2 (obese class III) HR 1.92 (95% CI 1.72–2.13), hypertension HR 0.89 (95% CI 0.85–0.93), CHD HR 1.17 (95% CI 1.12–1.22), reduced kidney function eGFR 30–60 mL/min/1.73 m2 HR 1.33 (95% CI 1.28–1.40), eGFR <30 mL/min/1.73 m2 HR 2.52 (95% CI 2.33–2.72), stroke/dementia HR 2.16 (95% CI 2.06–2.27), for death, adjusted for the same parameters as diabetes | Not examined |
| Holman et al. (33) | U.K. | 464 T1D COVID-19 deaths, 10,525 T2D COVID-19 deaths | T1D: HbA1c ≥10.0% (86 mmol/mol) HR 2.23, T2D: HbA1c 7.5–8.9% (59–74 mmol/mol) HR 1.22 (95% CI 1.15–1.30), HbA1c 9.0–9.9% (75–85 mmol/mol) HR 1.36 (95% CI 1.24–1.50), HbA1c ≥10.0% (86 mmol/mol) HR 1.61 (95% CI 1.47–1.77); all P < 0.0001, adjusted for age, sex, deprivation, ethnicity, clinical, CVD, CKD, among others | T1D: inverse relation of eGFR with HR; U-shape relation of BMI with HR, reference to overweight category (BMI 25.0–29.9 kg/m2); CVD HR>1, no significance of hypertension and cholesterol. T2D had the same risks, plus hypertension HR <1 | Not examined |
| Zhang et al. (34) | Wuhan, China | 166 | Diabetes and hyperglycemia secondary to COVID-19 increase the risk of critical disease (32.8% and 38.1%, respectively, vs. 9.5% overall, P < 0.05 for both) and composite outcome (ICU, mechanical ventilation use, death) | Hypertension was frequent in patients with diabetes and secondary hyperglycemia (P = 0.029) | Elevated WBC, neutrophils, ALT, AST, CRP, d-dimer, ESR, ferritin, IL-8, LDH, and N-terminal pro-BNP in COVID-19 patients with diabetes and hyperglycemia secondary vs. without diabetes and with normoglycemia |
| Wang et al. (35) | Wuhan, China | 605 | Admission FBG ≥7.0 mmol/L multivariate HR 2.30 (95% CI 1.49–3.55; P = 0.0002) for 28-day mortality; admission FBG ≥7.0 and 6.1–6.9 vs. <6.1 mmol/L OR 3.99 (95% CI 2.71–5.88) and 2.61 (95% CI 1.64–4.41), respectively, for 28-day in-hospital complications | Hypertension and CHD had no significant effect on 28-day mortality; CKD and cerebrovascular disease had univariate HR >1 for 28-day mortality | Not examined |
| Smith et al. (36) | NJ | 184 | Most patients had diabetes (62.0%) or prediabetes (23.9%); intubated patients had higher FBG (P = 0.013) and HbA1c (P = 0.034) vs. nonintubated | Most common preexisting conditions: hypertension (60.3%), hyperlipidemia (33.7%), dementia (13.0%), CKD (13.0%), CAD (12.0%), and CHD (10.9%); intubated patients had higher BMI (P = 0.030) vs. nonintubated | Not examined |
| Simonnet et al. (39) | Lille, France | 124 | Diabetes was not a risk factor in univariate logistic regression analysis | Obesity (≥35 kg/m2 BMI) univariate OR 6.75 (95% CI 1.76–25.85; P = 0.015), multivariate OR 7.36 (95% CI 1.63–33.14; P = 0.021); hypertension univariate OR 2.81 (95% CI 1.25–6.3; P = 0.012) but not significant in multivariate analysis; dyslipidemia was not a risk factor in univariate logistic regression analysis | Not examined |
| Gao et al. (41) | Wenzhou, China | 150 | Diabetes more prevalent in obese (24.0%) vs. nonobese (14.7%) COVID-19 patients | Obesity had OR 3.00 (95% CI 1.22–7.38) after adjustment for age, sex, smoking status, hypertension, diabetes, dyslipidemia | Elevated CRP and lymphopenia in obese vs. nonobese COVID-19 patients |
| Shi et al. (43) | Wuhan, China | 1,561, of whom 153 with diabetes analyzed vs. 153 age- and sex-matched 153 patients without diabetes | Diabetes (multivariate HR 1.58 [95% CI 0.84–2.99]) not an independent risk for in-hospital death; patients with diabetes likelier to be admitted to ICU and experience complications (ACI, AKI, ARDS, etc.) and death; nonsurvivor patients with diabetes likelier to have hypertension and CVD (P < 0.05); hypertension multivariate HR 3.10 (95% CI 1.14–8.44) for in-hospital death of patients with diabetes | Hypertension multivariate HR 2.50 (95% CI 1.30–4.78) and CVD multivariate HR 2.24 (95% CI 1.19–4.23) associated with in-hospital death | Elevated PCT and lower CD8+ T cells in patients with diabetes vs. patients without diabetes; elevated glucose, HbA1c, WBC, neutrophils, Cr, CRP, d-dimer, PCT, PT, and lymphopenia and lower eGFR, CD3+, CD4+, CD8+, CD19+, and CD16+56+ cells in nonsurvivor vs. survivor patients with diabetes |
| Lassale et al. (40) | U.K. | 640 COVID-19 hospitalizations from 340,966 registrants in UK Biobank subset from 900 COVID-19 hospitalizations and 428,494 registrants | Diabetes more prevalent and HbA1c higher in hospitalized vs. nonhospitalized patients (full data set), P < 0.001; Log HbA1c remained associated in multivariate analysis (OR 1.60 [95% CI 1.02–2.52]; P = 0.043; sub–data set); diabetes more prevalent in Black and Asian patients (full data set) | CVD, hypertension, BMI, WHR higher and cholesterol, HDL-c lower in hospitalized vs. nonhospitalized patients (full data set), P < 0.001; BMI, WHR, cholesterol remained significant in multivariate analysis; Black patients (OR 2.66 [95% CI 1.82–3.91]; P < 0.001) more susceptible to hospitalization, with adjustment for age, sex, comorbidities, and socioeconomic factors | Elevated CRP in hospitalized vs. nonhospitalized COVID-19 patients but did not remain significant in multivariate analysis |
| Price-Haywood et al. (45) | LA | 3,481 | 18.5% of Black patients had diabetes vs. 10.9% White. No analysis performed to disease severity. Black race was a hospitalization risk but not an independent in-hospital mortality risk | Charlson Comorbidity Index score OR 1.05 (95% CI 1.00–1.10) for hospitalization (accounting for race, age, sex, low-income area of residence, insurance plan, obesity) but HR 0.99 (95% CI 0.94–1.03) for in-hospital death; hypertension and CKD more prevalent in Black vs. White patients | Aside from other altered markers, AST, Cr, CRP, PCT, and lymphopenia had significant HR >1 for in-hospital death, after adjustment for race, age, sex, comorbidities, low-income area of residence, and laboratory measures |
| Study . | Location . | Participants (n) . | Diabetes findings . | Comorbidities findings* . | Select laboratory findings** . |
|---|---|---|---|---|---|
| Wang et al. (12) | Wuhan, China | 138 | Patients with diabetes constituted 22.2% of ICU patients vs. 5.9% of non-ICU patients, P = 0.009 | CVD, hypertension, cerebrovascular disease predisposed to ICU | Elevated WBC, neutrophils, ALT, AST, CK-MB, Cr, d-dimer, hs-TnI, LDH, PCT, and lymphopenia in ICU vs. non-ICU patients |
| Zhou et al. (13) | Wuhan, China | 191 | Patients with diabetes constituted 31% of nonsurvivors vs. 14% of survivors (P = 0.0051); OR 2.85 (95% CI 1.35–6.05; P = 0.0062) for in-hospital death in a univariate model | CVD, 24% nonsurvivors vs. 1% survivors (P < 0.0001), OR 21.40 (95% CI 4.64–98.76; P < 0.0001) in univariate model; hypertension, 48% nonsurvivors vs. 23% survivors (P = 0.0008), OR 3.05 (95% CI 1.57–5.92; P = 0.0010) in univariate model | Elevated WBC, ALT, CK, Cr, d-dimer, ferritin, hs-TnI, IL-6, LDH, PT, and PCT had significant HR >1 for death in univariate model; d-dimer had significant HR >1 for death in multivariate model |
| Guan et al. (14) | China | 1,099 | 16.2% of patients with severe vs. 5.7% with nonsevere COVID-19 infections had diabetes, and 26.9% that met vs. 6.1% that did not meet the primary composite end point (ICU, mechanical ventilation use, death) had diabetes; no P values | 5.8% of severe vs. 1.8% of nonsevere COVID-19 patients had CHD, and 9.0% that met vs. 2.0% that did not meet the primary composite end point had CHD; 23.7% of severe vs. 13.4% of nonsevere COVID-19 patients had hypertension, and 35.8% that met vs. 13.7% that did not meet the primary composite end point had hypertension; no P values | Elevated WBC, ALT, AST, CRP, d-dimer, LDH, PCT, and lymphopenia in severe vs. nonsevere infection and in patients that met vs. did not meet the primary composite end point, no P values |
| Wu and McGoogan (15) | China | 72,314 total, 44,672 confirmed (factored into CFR) | CFR 7.3% in patients with diabetes vs. 2.3% for the entire cohort | CFR 10.5% for CVD, 6.0% for hypertension | Not examined |
| Richardson et al. (17) | NYC area | 5,700 | Diabetes one of three most common morbidities. Patients with diabetes more likely to need mechanical ventilation or ICU | Hypertension and obesity two of three most common morbidities. Hypertensive patients less likely to need mechanical ventilation or ICU; 88% of COVID-19 patients had two or more comorbidities compared with one (6.3%) or none (6.1%). | Elevated ALT, AST, BNP, CRP, d-dimer, ferritin, LDH, PCT, and lymphopenia in hospitalized COVID-19 patients |
| Goyal et al. (18) | NYC | 393 | Diabetes was more frequent in patients requiring mechanical ventilation (27.7%) vs. not (24.0%) (P value not stated) | Hypertension, CAD, and obesity were more frequent in patients requiring mechanical ventilation (P values not stated) | Majority of patients had lymphopenia (90.0%), thrombocytopenia (27%); many had elevated liver function values and inflammatory markers (CRP, d-dimer, ferritin, PCT), which were further increased in patients requiring mechanical ventilation |
| Cummings et al. (5) | NYC | 1,150 | Diabetes one of three most common morbidities. Univariate HR 1.65 (95% CI 1.11–2.44), not significant in multivariate HR 1.31 (95% CI 0.81–2.10) for in-hospital mortality | Hypertension and obesity two of three most common morbidities. Hypertension univariate HR 2.24 (95% CI 1.40–3.59); CCD univariate HR 2.21 (95% CI 1.44–3.39), multivariate HR 1.76 (95% CI 1.08–2.86); BMI ≥40 kg/m2 not significant univariate HR 0.76 (95% CI 0.40–1.47) for in-hospital mortality; CKD was not a risk for in-hospital death | Aside from other altered markers, IL-6 univariate HR 1.12 (95% CI 1.04–1.21) and multivariate HR 1.11 (95% CI 1.02–1.20) and d-dimer univariate HR 1.18 (95% CI 1.10–1.27) and multivariate HR 1.10 (95% CI 1.01–1.19) for in-hospital mortality |
| Suleyman et al. (19) | Detroit, MI | 463 | Diabetes was more frequent in hospitalized (43.4%) vs. discharged (20.4%) patients (P < 0.001). It was also more frequent in ICU (51.8%) vs. non-ICU (38.8%) patients (P = 0.02) but was not a risk in multivariate analysis for ICU or mechanical ventilation. African American race was not more frequent in admitted or ICU vs. discharged patients or a risk for mechanical ventilation or death | Hypertension, CVD, obesity, and CKD were more frequent in hospitalized vs. discharged patients. Hypertension and CKD were also more frequent in ICU vs. non-ICU patients. CKD and severe obesity were risks in multivariate analysis for ICU or mechanical ventilation | Elevated AST, Cr, and hs-TnI; lower WBC; and lymphopenia in hospitalized vs. discharged patients by univariate analysis. Elevated WBC, AST, Cr, d-dimer, ferritin, hs-TnI, LDH, PCT, and lymphopenia in ICU vs. non-ICU patients by univariate analysis |
| Petrilli et al. (20) | NYC | 5,279 | Diabetes had multivariate OR 2.24 (95% CI 1.84–2.73; P < 0.001) for hospital admission, with adjustment for patient characteristics, comorbidities | All multivariate: heart failure OR 4.43 (95% CI 2.59–8.04; P < 0.001), hypertension OR 1.78 (95% CI 1.49–2.12; P < 0.001), CKD OR 2.6 (95% CI 1.89–3.61; P < 0.001), hyperlipidemia OR 0.62 (95% CI 0.52–0.74; P < 0.001), BMI 25.0–29.9 kg/m2 (overweight) OR 1.3 (95% CI 1.07–1.57; P = 0.007), BMI 30–39.9 kg/m2 (obese class I and II) OR 1.8 (95% CI 1.47–2.2; P < 0.001), BMI ≥40 kg/m2 (obese class III) OR 2.45 (95% CI 1.78–3.36; P < 0.001); all for hospital admission, adjusted for same variables as diabetes | Elevated Cr, CRP, d-dimer, PCT, troponin, and lymphopenia in critical COVID-19 |
| Dreher et al. (21) | Aachen, Germany | 50 | Diabetes did not raise the risk for ARDS; no P values | Obesity, but not hypertension, raised the risk for ARDS; no P values | Elevated WBC, CK, CRP, d-dimer, IL-6, LDH, and PCT; no P values |
| Wu et al. (22) | Wuhan, China | 201 | Diabetes was more frequent in ARDS (19.0%) than non-ARDS (5.1%) patients (P = 0.002); risk for ARDS (HR 2.34 [95% CI 1.35–4.05]; P = 0.002) but not death (HR 1.58 [95% CI 0.80–3.13]; P = 0.19) | Hypertension was more frequent in ARDS (27.4%) than non-ARDS (13.7%) patients (P = 0.02), risk for ARDS (HR 1.82 [95% CI 1.13–2.95]; P = 0.01) but not death (HR 1.70 [95% CI 0.92–3.14]; P = 0.09) | Elevated neutrophils, AST, CRP, d-dimer, ferritin, LDH, and PT had significant HR >1 for ARDS; neutrophils, d-dimer, IL-6, and LDH had significant HR >1 for death |
| Galloway et al. (23) | U.K. | 1,157 | Diabetes had HR (adjustment for sex, age) of 1.42 for critical care (95% CI 1.04–1.95; P = 0.029) | Hypertension had HR (adjusted for sex, age) of 1.53 for critical care or death (95% CI 1.24–1.90; P = 0.000) | Neutrophils, Cr, and CRP had significant HR >1 for critical care or death |
| Liang et al. (24) | China | 1,590, discovery cohort; 710, validation cohort; risk score for critical illness | 6.8% noncritical vs. 23.7% critical disease among patients with diabetes | 3.2% noncritical vs. 9.9% critical disease among CVD patients; 14.8% noncritical vs. 40.5% critical disease among hypertension patients. Number of comorbidities had OR 1.60 (95% CI 1.27–2.00; P < 0.001) in multivariate analysis | Aside from other altered markers, neutrophil-to-lymphocyte ratio (OR 1.06 [95% CI 1.02–1.10]; P = 0.003) and LDH (OR 1.002 [95% CI 1.001–1.004]; P < 0.001) integrated into a 10-point risk score for critical illness |
| Cariou et al. (25) | France | 1,317, of whom 1,166 with T2D | Diabetes type, HbA1c, glucose-lowering therapy use did not affect primary outcome (mechanical ventilation and/or death within 7 days of admission) in univariate analysis | Micro- (OR 2.14 [95% CI 1.16–3.94]; P = 0.0153) and macrovascular (OR 2.54 [95% CI 1.44–4.50]; P = 0.0013) complications independently associated with 7-day mortality; BMI multivariate OR 1.28 (95% CI 1.10–1.47), P < 0.0010 for composite | AST (OR 2.23 [95% CI 1.70–2.93]; P < 0.0001) and CRP (OR 1.93 [95% CI 1.43–2.59]; P < 0.0001) independently associated with primary outcome; higher lymphocytes were protective (OR 0.67 [95% CI 0.50–0.88]; P = 0.0050) |
| Barron et al. (26) | U.K. | 23,698 COVID-19 deaths, 364 T1D COVID-19 deaths, 7,434 T2D COVID-19 deaths | T1D OR 2.86 (95% CI 2.58–3.18; P < 0.001) and T2D OR 1.80 (95% CI 1.75–1.86; P < 0.001) for death, with adjustment for age, sex, deprivation, ethnicity, CVD, cerebrovascular disease | CVD and cerebrovascular disease more frequent in T1D and T2D vs. nondiabetes in COVID-19 deaths | Not examined |
| Zhang et al. (27) | Wuhan, China | 258, of whom 63 with diabetes | Diabetes had multivariate HR 3.64 (95% CI 1.09–12.21; P = 0.036); elevated FBG (>7.54 mmol) had multivariate HR 1.19 (95% CI 1.08–1.31; P < 0.001); both for death adjusted for age, CVD, CKD, inflammatory markers | CVD more frequent in patients with diabetes (23.8%) vs. patients without diabetes (12.3%), P = 0.027; CKD more frequent in patients with diabetes (8.8%) vs. patients without patients (2.1%), P = 0.027 | Elevated WBC, neutrophils, CK-MB, d-dimer, TT in patients with diabetes vs. patients without diabetes |
| Guo et al. (28) | Wuhan, China | 174, overall analysis; 50, subgroup analysis | Patients with diabetes without any other comorbidities (16.5%) died more often than patients without diabetes without comorbidities (0%) (P = 0.03); however, the latter patients were younger | CVD was more prevalent in patients with diabetes, P = 0.013 | Elevated neutrophils, d-dimer, and ESR, and lymphopenia in patients with diabetes vs. patients without diabetes; neutrophils, ALT, CRP, d-dimer, ESR, ferritin, IL-6, LDH, and lymphopenia in patients with diabetes vs. patients without diabetes without comorbidities; however, the latter patients were younger |
| Zhu et al. (3) | Hubei Province, China | 7,337, of whom 952 with T2D | T2D patients had higher mortality: 7.8% vs. 2.7% overall, adjusted HR 1.49 (95% CI 1.13–1.96; P = 0.005); well-controlled blood glucose confers lower all-cause mortality, adjusted HR 0.14 (95% CI 0.03–0.60; P = 0.008) | Blood glucose correlated with comorbid CHD, hypertension | T2D patients had elevated WBC, neutrophils, Cr, CRP, d-dimer, IL-6, LDH, PCT, and lymphopenia vs. patients without diabetes; T2D patients with well-controlled vs. poorly controlled blood glucose had significantly fewer incidences of elevated WBC, neutrophils, ALT, AST, Cr, CRP, d-dimer, PCT, and lymphopenia; no P values |
| Iacobellis et al. (29) | Miami, FL | 85 | Admission hyperglycemia best predicted poor chest radiological outcomes | BMI correlated with poor chest radiological outcomes | Not examined |
| Li et al. (30) | Wuhan, China | 132, of whom 130 with T2D | Patients with diabetes stratified by admission glucose: group 1 (≤11 mmol/L) vs. group 2 (>11 mmol/L); group 2 had longer diabetes duration, more likely to suffer ACI, ICU admission, death | No difference in comorbidities in group 1 vs. group 2 | Elevated WBC, CRP, d-dimer, ESR, IL-6, and lymphopenia in group 2 vs. group 1; WBC (>109/L), Cr (<57/0 µmol/L), d-dimer (≥1.5 µg/L), hs-TnI (>26.2 pg/mL), LDH (>245 units/L), PCT univariate OR >1 for in-hospital complications |
| Chao et al. (31) | Taiwan | 452 | High glucose variability within the first day of ICU admission correlated with 30-day mortality, particularly in patients without diabetes. High glucose variability was more frequent in patients with diabetes | Except for diabetes, no difference in other comorbidities (e.g., CKD, CHD, cerebrovascular disease) in patients with high vs. low glucose variability; APACHE II score independently correlated with higher 30-day mortality | No differences in Cr, CRP, and PCT in patients with high vs. low glucose variability |
| Bode et al. (32) | U.S. | 1,122 | Diabetes and/or uncontrolled hyperglycemia increased hospital length of stay and mortality | Kidney function, as assessed by eGFR, was lower in patients with diabetes and/or uncontrolled hyperglycemia at admission | Elevated Cr in patients with diabetes and/or uncontrolled hyperglycemia vs. patients without diabetes or with controlled blood glucose patients |
| Williamson et al. (4) | U.K. | 10,926 COVID-19 deaths vs. 17,278,392 control subjects | Diabetes with HbA1c <7.5% (58 mmol/mol), HR 1.31 (95% CI 1.24–1.37), and with HbA1c ≥7.5% (58 mmol/mol), HR 1.95 (95% CI 1.83–2.07), for death, adjusted for age, sex, comorbidities, smoking, socioeconomic status. Mixed race, HR 1.43 (95% CI 1.11–1.85); South Asian, HR 1.44 (95% CI 1.32–1.58); and Black, HR 1.48 (95% CI 1.30–1.69); risks for death after adjustment for the same variables | BMI 30–34.9 kg/m2 (obese class I) nonsignificant HR 1.05 (95% CI 1.00–1.11), BMI 35–39.9 kg/m2 (obese class II) HR 1.40 (95% CI 1.30–1.52), BMI ≥40 kg/m2 (obese class III) HR 1.92 (95% CI 1.72–2.13), hypertension HR 0.89 (95% CI 0.85–0.93), CHD HR 1.17 (95% CI 1.12–1.22), reduced kidney function eGFR 30–60 mL/min/1.73 m2 HR 1.33 (95% CI 1.28–1.40), eGFR <30 mL/min/1.73 m2 HR 2.52 (95% CI 2.33–2.72), stroke/dementia HR 2.16 (95% CI 2.06–2.27), for death, adjusted for the same parameters as diabetes | Not examined |
| Holman et al. (33) | U.K. | 464 T1D COVID-19 deaths, 10,525 T2D COVID-19 deaths | T1D: HbA1c ≥10.0% (86 mmol/mol) HR 2.23, T2D: HbA1c 7.5–8.9% (59–74 mmol/mol) HR 1.22 (95% CI 1.15–1.30), HbA1c 9.0–9.9% (75–85 mmol/mol) HR 1.36 (95% CI 1.24–1.50), HbA1c ≥10.0% (86 mmol/mol) HR 1.61 (95% CI 1.47–1.77); all P < 0.0001, adjusted for age, sex, deprivation, ethnicity, clinical, CVD, CKD, among others | T1D: inverse relation of eGFR with HR; U-shape relation of BMI with HR, reference to overweight category (BMI 25.0–29.9 kg/m2); CVD HR>1, no significance of hypertension and cholesterol. T2D had the same risks, plus hypertension HR <1 | Not examined |
| Zhang et al. (34) | Wuhan, China | 166 | Diabetes and hyperglycemia secondary to COVID-19 increase the risk of critical disease (32.8% and 38.1%, respectively, vs. 9.5% overall, P < 0.05 for both) and composite outcome (ICU, mechanical ventilation use, death) | Hypertension was frequent in patients with diabetes and secondary hyperglycemia (P = 0.029) | Elevated WBC, neutrophils, ALT, AST, CRP, d-dimer, ESR, ferritin, IL-8, LDH, and N-terminal pro-BNP in COVID-19 patients with diabetes and hyperglycemia secondary vs. without diabetes and with normoglycemia |
| Wang et al. (35) | Wuhan, China | 605 | Admission FBG ≥7.0 mmol/L multivariate HR 2.30 (95% CI 1.49–3.55; P = 0.0002) for 28-day mortality; admission FBG ≥7.0 and 6.1–6.9 vs. <6.1 mmol/L OR 3.99 (95% CI 2.71–5.88) and 2.61 (95% CI 1.64–4.41), respectively, for 28-day in-hospital complications | Hypertension and CHD had no significant effect on 28-day mortality; CKD and cerebrovascular disease had univariate HR >1 for 28-day mortality | Not examined |
| Smith et al. (36) | NJ | 184 | Most patients had diabetes (62.0%) or prediabetes (23.9%); intubated patients had higher FBG (P = 0.013) and HbA1c (P = 0.034) vs. nonintubated | Most common preexisting conditions: hypertension (60.3%), hyperlipidemia (33.7%), dementia (13.0%), CKD (13.0%), CAD (12.0%), and CHD (10.9%); intubated patients had higher BMI (P = 0.030) vs. nonintubated | Not examined |
| Simonnet et al. (39) | Lille, France | 124 | Diabetes was not a risk factor in univariate logistic regression analysis | Obesity (≥35 kg/m2 BMI) univariate OR 6.75 (95% CI 1.76–25.85; P = 0.015), multivariate OR 7.36 (95% CI 1.63–33.14; P = 0.021); hypertension univariate OR 2.81 (95% CI 1.25–6.3; P = 0.012) but not significant in multivariate analysis; dyslipidemia was not a risk factor in univariate logistic regression analysis | Not examined |
| Gao et al. (41) | Wenzhou, China | 150 | Diabetes more prevalent in obese (24.0%) vs. nonobese (14.7%) COVID-19 patients | Obesity had OR 3.00 (95% CI 1.22–7.38) after adjustment for age, sex, smoking status, hypertension, diabetes, dyslipidemia | Elevated CRP and lymphopenia in obese vs. nonobese COVID-19 patients |
| Shi et al. (43) | Wuhan, China | 1,561, of whom 153 with diabetes analyzed vs. 153 age- and sex-matched 153 patients without diabetes | Diabetes (multivariate HR 1.58 [95% CI 0.84–2.99]) not an independent risk for in-hospital death; patients with diabetes likelier to be admitted to ICU and experience complications (ACI, AKI, ARDS, etc.) and death; nonsurvivor patients with diabetes likelier to have hypertension and CVD (P < 0.05); hypertension multivariate HR 3.10 (95% CI 1.14–8.44) for in-hospital death of patients with diabetes | Hypertension multivariate HR 2.50 (95% CI 1.30–4.78) and CVD multivariate HR 2.24 (95% CI 1.19–4.23) associated with in-hospital death | Elevated PCT and lower CD8+ T cells in patients with diabetes vs. patients without diabetes; elevated glucose, HbA1c, WBC, neutrophils, Cr, CRP, d-dimer, PCT, PT, and lymphopenia and lower eGFR, CD3+, CD4+, CD8+, CD19+, and CD16+56+ cells in nonsurvivor vs. survivor patients with diabetes |
| Lassale et al. (40) | U.K. | 640 COVID-19 hospitalizations from 340,966 registrants in UK Biobank subset from 900 COVID-19 hospitalizations and 428,494 registrants | Diabetes more prevalent and HbA1c higher in hospitalized vs. nonhospitalized patients (full data set), P < 0.001; Log HbA1c remained associated in multivariate analysis (OR 1.60 [95% CI 1.02–2.52]; P = 0.043; sub–data set); diabetes more prevalent in Black and Asian patients (full data set) | CVD, hypertension, BMI, WHR higher and cholesterol, HDL-c lower in hospitalized vs. nonhospitalized patients (full data set), P < 0.001; BMI, WHR, cholesterol remained significant in multivariate analysis; Black patients (OR 2.66 [95% CI 1.82–3.91]; P < 0.001) more susceptible to hospitalization, with adjustment for age, sex, comorbidities, and socioeconomic factors | Elevated CRP in hospitalized vs. nonhospitalized COVID-19 patients but did not remain significant in multivariate analysis |
| Price-Haywood et al. (45) | LA | 3,481 | 18.5% of Black patients had diabetes vs. 10.9% White. No analysis performed to disease severity. Black race was a hospitalization risk but not an independent in-hospital mortality risk | Charlson Comorbidity Index score OR 1.05 (95% CI 1.00–1.10) for hospitalization (accounting for race, age, sex, low-income area of residence, insurance plan, obesity) but HR 0.99 (95% CI 0.94–1.03) for in-hospital death; hypertension and CKD more prevalent in Black vs. White patients | Aside from other altered markers, AST, Cr, CRP, PCT, and lymphopenia had significant HR >1 for in-hospital death, after adjustment for race, age, sex, comorbidities, low-income area of residence, and laboratory measures |
ALT, alanine aminotransferase; APACHE II, Acute Physiology and Chronic Health Evaluation II; BNP, brain natriuretic peptide; CAD, coronary artery disease; CCD, chronic cardiac disease; CFR, case fatality rate; CHD, coronary heart disease; CK, creatine kinase; CK-MB, creatine kinase, muscle and brain type; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; FBG, fasting blood glucose; HDL-c, high-density lipoprotein cholesterol; IL-6, interleukin 6; PT, prothrombin time; T1D, type 1 diabetes; T2D, type 2 diabetes; TT, thrombin time.
Conditions comorbid with diabetes considered.
Select laboratory findings for significant differences reported in immune cell populations, cytokines, and biomarkers of infection and kidney, liver, and cardiac damage. Changes were reported if there were significant differences in either mean values or in the number of patients above a cutoff value.