Highlights
- •Investigates the indirect impact of the pandemic on T2DM patients without infection.
- •Meta-analysis shows that hemoglobin A1c and body mass index changed insignificantly.
- •Meta-analysis shows that triglyceride and total cholesterol might worsen.
Abstract
Background
Methods
Results
Conclusions
Systematic review registration
Abbreviations:
SARS-CoV-2 (coronavirus type 2), COVID-19 (coronavirus disease 2019), T2DM (type 2 diabetes mellitus), HbA1% (glycated hemoglobin), BMI (body mass index), BP (blood pressure), SBP/DBP (systolic pressure / diastolic pressure), TG (triglyceride), TC (total cholesterol), LDL (low-density lipoprotein), HDL (high-density lipoprotein), PICOS (population, intervention, control, outcome, and study design), 95% CI (95% confidence intervals), JBI (Joanna Briggs Institute), IQR (interquartile range), SD (standard deviation), WMD (weighted mean difference)Keywords
1. Background
- Zhu L.
- She Z.G.
- Cheng X.
- Qin J.J.
- Zhang X.J.
- Cai J.
- Lei F.
- Wang H.
- Xie J.
- Wang W.
- Li H.
- Zhang P.
- Song X.
- Chen X.
- Xiang M.
- Zhang C.
- Bai L.
- Xiang D.
- Chen M.M.
- Liu Y.
- Yan Y.
- Liu M.
- Mao W.
- Zou J.
- Liu L.
- Chen G.
- Luo P.
- Xiao B.
- Zhang C.
- Zhang Z.
- Lu Z.
- Wang J.
- Lu H.
- Xia X.
- Wang D.
- Liao X.
- Peng G.
- Ye P.
- Yang J.
- Yuan Y.
- Huang X.
- Guo J.
- Zhang B.H.
- Li H.
- Ruissen M.M.
- Regeer H.
- Landstra C.P.
- Schroijen M.
- Jazet I.
- Nijhoff M.F.
- Pijl H.
- Ballieux B.E.P.B.
- Dekkers O.
- Huisman S.D.
- de Koning E.J.P.
- Ghosh A.
- Anjana R.M.
- Shanthi Rani C.S.
- Jeba Rani S.
- Gupta R.
- Jha A.
- Gupta V.
- Kuchay M.S.
- Luthra A.
- Durrani S.
- Dutta K.
- Tyagi K.
- Unnikrishnan R.
- Srivastava B.K.
- Ramu M.
- Sastry N.G.
- Gupta P.K.
- Umasankari G.
- Jayashri R.
- Mohan V.
- Misra A.
- Ammar A.
- Brach M.
- Trabelsi K.
- Chtourou H.
- Boukhris O.
- Masmoudi L.
- Bouaziz B.
- Bentlage E.
- How D.
- Ahmed M.
- Müller P.
- Müller N.
- Aloui A.
- Hammouda O.
- Paineiras-Domingos L.L.
- Braakman-Jansen A.
- Wrede C.
- Bastoni S.
- Pernambuco C.S.
- Mataruna L.
- Taheri M.
- Irandoust K.
- Khacharem A.
- Bragazzi N.L.
- Chamari K.
- Glenn J.M.
- Bott N.T.
- Gargouri F.
- Chaari L.
- Batatia H.
- Ali G.M.
- Abdelkarim O.
- Jarraya M.
- Abed K.E.
- Souissi N.
- Van Gemert-Pijnen L.
- Riemann B.L.
- Riemann L.
- Moalla W.
- Gómez-Raja J.
- Epstein M.
- Sanderman R.
- Schulz S.V.
- Jerg A.
- Al-Horani R.
- Mansi T.
- Jmail M.
- Barbosa F.
- Ferreira-Santos F.
- Šimunič B.
- Pišot R.
- Gaggioli A.
- Bailey S.J.
- Steinacker J.M.
- Driss T.
- Hoekelmann A.
2. Materials and methods
2.1 Data sources and searching strategy
2.2 Study selection
2.3 Screening process, quality assessment, and data extraction
2.4 Outcomes of interest
- Elam M.B.
- Ginsberg H.N.
- Lovato L.C.
- Corson M.
- Largay J.
- Leiter L.A.
- Lopez C.
- O’Connor P.J.
- Sweeney M.E.
- Weiss D.
- Friedewald W.T.
- Buse J.B.
- Gerstein H.C.
- Probstfield J.
- Grimm R.
- Ismail-Beigi F.
- Goff Jr., D.C.
- Fleg J.L.
- Rosenberg Y.
- Byington R.P.
- Investigators A.S.
2.5 Data synthesis and analysis
3. Results
3.1 Literature collection and general data

Source | Country | Study design | Sample size, n | Male, % | Mean age ± SD, years | Control (Pre-pandemic) | Span | Endpoint (Pandemic) | Outcome | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Glycemic parameter | Lipid profile | BMI | |||||||||
Munekawa et al., Sep 2020 | Kyoto, Japan | Retrospective cohort | 183 | 62.1 | 67.4 ± 11.3 | Jan-Feb, 2020 | Apr-May 2020 | Increased | No significant change* | ||
Rastogi et al., Oct 2020 | Chandigarh, India | Prospective cohort | 442 | 71.8 | median (range) 58 (52–64) | Pre-lockdown | Immediately after the lockdown lifted | Decreased | No significant change | ||
Onmez et al., Oct 2020 | Duzce, Turkey | Retrospective† | 101 | 56.5 | 55 ± 13 | Pre-lockdown | 1 month after the lockdown lifted | No significant change | No significant change | ||
Karatas et al. Jan 2021 | Istanbul, Turkey | Case-control† | 85 | 31.8 | 55.8 ± 10.5 | Pre-lockdown | 6 months after pre-lockdown | Increased | Increased | Increased | |
D’Onofrio et al. Mar 2021 | Lazio, Italy | Retrospective, case-control† | 141 | 61 | median (range) 68 (61–74) | December 9 2019 – March 9 2020 | 1 month after the lockdown lifted | No significant difference | No significant difference | No significant difference | |
Falcetta et al. Mar 2021 | Pisa, Italy | Retrospective cohort | 304 | 65 | 69.1 ± 9.2 | Pre-lockdown | 1 month after the lockdown lifted | No significant difference | Decreased | Increased | |
Biamonte et al. Jun 2021 | Rozzano, Italy | Retrospective† | 128 | 57.8 | median (range) 70 (40–91) | Pre-lockdown | 1 month after the lockdown lifted | Increased | Increased | ||
Verma et al. Oct 2021 | Bathinda, India | Cross-sectional† | 20 | 61.2 | 51.5 ± 11.3 | Pre-lockdown | 1–3 months after lockdown lifted | Decreased* | |||
Jin et al. Oct 2021 | Daegu, Korea | Retrospective† | 996 | 60.5 | 62.9 ± 11.3 | January 1–18 Feb 2020 | Jul- Aug 2020 | Increased | |||
Selek et al. Dec 2021 | Kocaeli, Turkey | Retrospective† | 283 | 47 | 58.0 ± 12.1 | Pre-pandemic | 15 days - 5 months after lockdown lifted | No significant difference | Increased* | No significant difference | |
Alowainati et al. Dec 2021 | Doha, Qatar | Retrospective† | 509 | 41.3 | 55.8 ± 13.4 | Pre-lockdown | Immediately after the lockdown lifted | No significant difference |

3.2 Effect on HbA1c
- Alowainati B.
- Dabbous Z.
- Salameh O.
- Hamad M.
- Al Hail L.
- Abuheliqa W.
- AL-Janahi I.
- Jayyousi A.
- Zirie M.
- Munekawa C.
- Hosomi Y.
- Hashimoto Y.
- Okamura T.
- Takahashi F.
- Kawano R.
- Nakajima H.
- Osaka T.
- Okada H.
- Majima S.
- Senmaru T.
- Nakanishi N.
- Ushigome E.
- Hamaguchi M.
- Yamazaki M.
- Fukui M.

3.3 Effect on lipid profiles
American Heart Association, What Your Cholesterol Levels Mean, 2020. 〈https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/what-your-cholesterol-levels-mean〉.

3.4 Effect on BMI and BP
- Munekawa C.
- Hosomi Y.
- Hashimoto Y.
- Okamura T.
- Takahashi F.
- Kawano R.
- Nakajima H.
- Osaka T.
- Okada H.
- Majima S.
- Senmaru T.
- Nakanishi N.
- Ushigome E.
- Hamaguchi M.
- Yamazaki M.
- Fukui M.

4. Discussion
4.1 Effect on HbA1c and BMI
- Gobbi E.
- Maltagliati S.
- Sarrazin P.
- di Fronso S.
- Colangelo A.
- Cheval B.
- Escriva-Boulley G.
- Tessier D.
- Demirhan G.
- Erturan G.
- Yüksel Y.
- Papaioannou A.
- Bertollo M.
- Carraro A.
4.2 Effect on lipid panel
4.3 Effect on healthcare disruption
Department of Health and Social Care UK, COVID-19 Response – 2021 Spring. Available: 〈https://www.gov.uk/government/publications/covid-19-response-spring-2021〉, (Accessed February 2023).
4.4 Effect on lifestyle changes
- Ammar A.
- Brach M.
- Trabelsi K.
- Chtourou H.
- Boukhris O.
- Masmoudi L.
- Bouaziz B.
- Bentlage E.
- How D.
- Ahmed M.
- Müller P.
- Müller N.
- Aloui A.
- Hammouda O.
- Paineiras-Domingos L.L.
- Braakman-Jansen A.
- Wrede C.
- Bastoni S.
- Pernambuco C.S.
- Mataruna L.
- Taheri M.
- Irandoust K.
- Khacharem A.
- Bragazzi N.L.
- Chamari K.
- Glenn J.M.
- Bott N.T.
- Gargouri F.
- Chaari L.
- Batatia H.
- Ali G.M.
- Abdelkarim O.
- Jarraya M.
- Abed K.E.
- Souissi N.
- Van Gemert-Pijnen L.
- Riemann B.L.
- Riemann L.
- Moalla W.
- Gómez-Raja J.
- Epstein M.
- Sanderman R.
- Schulz S.V.
- Jerg A.
- Al-Horani R.
- Mansi T.
- Jmail M.
- Barbosa F.
- Ferreira-Santos F.
- Šimunič B.
- Pišot R.
- Gaggioli A.
- Bailey S.J.
- Steinacker J.M.
- Driss T.
- Hoekelmann A.
- Lehtisalo J.
- Palmer K.
- Mangialasche F.
- Solomon A.
- Kivipelto M.
- Ngandu T.
4.5 Strengths and limitations
- Mak I.L.
- Wan E.Y.F.
- Wong T.K.T.
- Lee W.W.J.
- Chan E.W.Y.
- Choi E.P.H.
- Chui C.S.L.
- Ip M.S.M.
- Lau W.C.S.
- Lau K.K.
- Lee S.F.
- Wong I.C.K.
- Yu E.Y.T.
- Lam C.L.K.
5. Conclusion
Funding
Ethics approval and consent to participate
Consent for publication
CRediT authorship contribution statement
Declaration of Competing Interest
Acknowledgments
Appendix A. Supplementary material
Supplementary material
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