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?:abstract
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Introduction: Only 3 types of coronavirus cause aggressive respiratory disease in humans (MERS-Cov, SARS-Cov-1, and SARS-Cov-2) It has been reported higher infection rates and severe manifestations (ICU admission, need for mechanical ventilation, and death) in patients with comorbidities such as diabetes mellitus (DM) For this reason, this study aimed to determine the prevalence of diabetes comorbidity and its associated unfavorable health outcomes in patients with acute respiratory syndromes for coronavirus disease according to virus types Methods: Systematic review of literature in Pubmed/Medline, Scopus, Web of Science, Cochrane, and Scielo until April of 2020 We included cohort and cross-sectional studies with no restriction by language or geographical zone The selection and extraction were undertaken by 2 reviewers, independently The study quality was evaluated with Loney’s instrument and data were synthesized by random effects model meta-analysis The heterogeneity was quantified using an I2 statistic Funnel plot, Egger, and Begg tests were used to evaluate publication biases, and subgroups and sensitivity analyses were performed Finally, we used the GRADE approach to assess the evidence certainty (PROSPERO: CRD42020178049) Results: We conducted the pooled analysis of 28 studies (n = 5960) The prevalence analysis according to virus type were 451 9 diabetes cases per 1000 infected patients (95% CI: 356 74-548 78;I2 = 89 71%) in MERS-Cov;90 38 per 1000 (95% CI: 67 17-118 38) in SARS-Cov-1;and 100 42 per 1000 (95% CI: 77 85, 125 26 I2 = 67 94%) in SARS-Cov-2 The mortality rate were 36%, 6%, 10% and for MERS-Cov, SARS-Cov-1, and SARS-Cov-2, respectively Due to the high risk of bias (75% of studies had very low quality), high heterogeneity (I2 higher than 60%), and publication bias (for MERS-Cov studies), we down rate the certainty to very low Conclusion: The prevalence of DM in patients with acute respiratory syndrome due to coronaviruses is high, predominantly with MERS-Cov infection The unfavorable health outcomes are frequent in this subset of patients Well-powered and population-based studies are needed, including detailed DM clinical profile (such as glycemic control, DM complications, and treatment regimens), comorbidities, and SARS-Cov-2 evolution to reevaluate the worldwide prevalence of this comorbidity and to typify clinical phenotypes with differential risk within the subpopulation of DM patients
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