Yang, Y., Zixin, C. & Zhang, J. | 2021| Insulin Treatment May Increase Adverse Outcomes in Patients With COVID-19 and Diabetes: A Systematic Review and Meta-Analysis | Frontiers in Endocrinology | https://doi.org/10.3389/fendo.2021.696087
The reviewers invovlved in this analysis, conducted a systematic review and meta-analysis to determine the association between insulin injection and the outcomes of COVID-19 to provide certain clinical information for patients with Covid-19 and diabetes. They recognise that while their findings may provide evidence of the adverse effect of insulin treatment among patients with COVID-19 and diabetes, especially among those with type 2 diabetes (T2DM), as the subjects in most included studies suffered from T2DM. However, considering the limited number of studies concerning type 1 diabetes (T1DM) in our meta-analysis, the association between insulin treatment and adverse outcomes in patients with COVID-19 and T1DM are needed to be investigated in more large-scale clinical studies (Source: Yang, Zixin & Zhang, 2021).
Background and Objective:
Recently, insulin treatment has been found to be associated with increased mortality and other adverse outcomes in patients with coronavirus disease 2019 (COVID-19) and diabetes, but the results remain unclear and controversial, therefore, we conducted this meta-analysis.
Four databases, namely, PubMed, Web of Science, EMBASE and the Cochrane Library, were used to identify all studies concerning insulin treatment and the adverse effects of COVID-19, including mortality, incidence of severe/critical complications, in-hospital admission and hospitalization time. To assess publication bias, funnel plots, Begg’s tests and Egger’s tests were used. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the effect of insulin therapy on mortality, severe/critical complications and in-hospital admission. The association between insulin treatment and hospitalization time was calculated by the standardized mean difference (SMD) with 95% CIs.
Eighteen articles, involving a total of 12277 patients with COVID-19 and diabetes were included. Insulin treatment was significantly associated with an increased risk of mortality (OR=2.10; 95% CI, 1.51-2.93) and incidence of severe/critical COVID-19 complications (OR=2.56; 95% CI, 1.18-5.55). Moreover, insulin therapy may increase in-hospital admission in patients with COVID-19 and diabetes (OR=1.31; 95% CI, 1.06-1.61). However, there was no significant difference in the hospitalization time according to insulin treatment (SMD=0.21 95% CI, -0.02-0.45).
Insulin treatment may increase mortality and severe/critical complications in patients with COVID-19 and diabetes, but more large-scale studies are needed to confirm and explore the exact mechanism.