Morbidity and Mortality among Diabetes Patients Co-infected with COVID-19, by World Health Organization Region, 2020 – 2021 Open Access

Joharji, Afnan (Fall 2021)

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Introduction: Corona virus 2019 (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2). [1] First discovered in Wuhan, China, COVID-19 rapidly spread and was declared a pandemic Feb 11, 2020 by the World Health Organization (WHO). [1] As of Sep 18, 2021 there have been 241,411,380 cases and approximately five million deaths worldwide.[2] Evidence indicates that outcomes from COVID-19 (e.g., acute respiratory syndrome [ARDS], ICU admission, and death) are worse in those with co-morbidities (e.g., hypertension and type-2 diabetes mellites [T2DM]). [3-5] T2DM is a chronic, metabolic, syndrome disorder affecting > 400 million globally. [6],[7] This systematic literature review studied the relationship of T2DM and COVID-19 outcomes (i.e., disease severity and mortality) by WHO region.

Methods: A systematic literature review was performed using PubMed with the following search terms: "COVID-19" OR "SARS-CoV-2" AND "Diabetes" 2) "COVID-19" OR "SARS-CoV-2" AND "Characteristics". Inclusion criteria were in-patients and out-patients with confirmed COVID-19 and T2DM, with the related outcomes (i.e., disease severity, ventilation, ICU admission, ARDS, and death). 

Results: This systematic literature review assessed 31 peer-reviewed articles on the relationship between severity and mortality of COVID-19 patients and T2DM by WHO region (i.e., Asia, Middle East, Europe, North America, Latin America) between Feb 1, 2020, and March 31, 2021. People with T2DM were more vulnerable to COVID-19 complications (severe disease or death). The Asia region had the greatest number of studies with high numbers of T2DM prevalence; however, Europe had the highest pooled RR among COVID-19 patients with T2DM and without T2DM.

Conclusion: This systematic review found COVID-19 severity and mortality among patients with T2DM differed by WHO region. This complication may be mitigated by insulin-control. More research is needed in this field to prove whether the outcomes of COVID-19 among T2DM patients differ by WHO region and why.

Table of Contents

Table of Contents


Literature Review

Burden of global T2DM

Prevalence of T2DM among COVID-19 cases

Mechanism linking T2DM to COVID-19

Severity and mortality outcomes related to T2DM

Summary of current problem and study relevance


Search strategy and study selection

Eligibility criteria

Statistical analysis



Summary of evidence



Public health implications



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