Impact of Diabetes on the Risk and Outcomes of Mucormycosis in COVID-19 Patients: A Systematic Review and Meta-Analysis.

Abstract

Introduction: The COVID-19 pandemic has precipitated a surge in secondary infections, notably mucormycosis, particularly among individuals with diabetes mellitus. This review explores the impact of diabetes on the prevalence and outcomes of COVID-19-associated mucormycosis (CAM), with a focus on mortality and the compounding role of corticosteroid therapy.

Objectives: The present study aimed to systematically evaluate the impact of diabetes mellitus on the prevalence and mortality of COVID-19-associated mucormycosis (CAM), and to assess the modifying role of corticosteroid therapy.

Methods: This systematic review and meta-analysis were conducted following the PRISMA guidelines and registered in PROSPERO (ID: CRD42024590439). A comprehensive search of PubMed, Cochrane Library, and EBSCOhost up to September 23, 2024, identified 750 records. Sixteen studies meeting the inclusion criteria were included. Data were extracted on prevalence, mortality, steroid use, and hypertension, and analyzed using a random-effects model. Heterogeneity and publication bias were assessed using I² statistics and Egger’s test.

Results: A total of 16 studies were included in this review. Diabetes mellitus emerged as the most common comorbidity among COVID-19 patients with mucormycosis, indicating a strong association with increased CAM risk. The meta-analysis revealed a significant pooled estimate for diabetes (intercept = 84.2, p < 0.001), with moderate heterogeneity (I² = 60.96%). Publication bias assessments, including Egger’s regression and Kendall’s Tau, indicated no significant bias. The analyses on steroid use and hypertension also demonstrated significant associations with CAM, though with substantial heterogeneity (I² > 90%). Overall, the findings underscore diabetes and steroid therapy as major contributors to CAM prevalence and adverse outcomes.

Conclusions: This study highlights the crucial importance of strict glycemic control and cautious corticosteroid use in diabetic patients with COVID-19 to minimize CAM risk. Public health strategies should prioritize early screening and tailored management. Future research should explore biological mechanisms and alternative therapies to reduce CAM incidence.