COVID-19, Diabetes, and Associated Health Outcomes in China: Results from a Nationwide Survey of 10 545 Adults

  1. Zumin Shi
  2. Alice Yan
  3. Paul Zimmet
  4. Xiaoming Sun
  5. Nayla Cristina do Vale Moreira
  6. Lawrence J. Cheskin
  7. Liming Wang
  8. Weidong Qu
  9. Hong Yan
  10. Akhtar Hussain
  11. Youfa Wang

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Abstract

This study examined the associations between diabetes and self-reported/familial COVID-19 infection and investigated health-related outcomes among those with diabetes during China’s nationwide quarantine. The 2020 China COVID-19 Survey was administered anonymously via social media (WeChat). It was completed by 10 545 adults in all of mainland China’s 31 provinces. The survey consisted of 74 items covering sociodemographic characteristics, preventive measures for COVID-19, lifestyle behaviors, and health-related outcomes during the period of quarantine. Regression models examined associations among study variables. Diabetes was associated with a six-fold increased risk of reporting COVID-19 infection among respondents or their family members. Among people with diabetes, individuals who rarely wore masks had double the risk of suspected COVID-19 infection compared with those who always wore masks, with an inverse J-shaped relationship between face mask wearing and suspected COVID-19 infection. People with diabetes tended to have both poor knowledge of COVID-19 and poor compliance with preventive measures, despite perceiving a high risk of personal infection (40.0% among respondents reporting diabetes and 8.0% without diabetes). Only 54–55% of these respondents claimed to consistently practice preventive measures, including wearing face masks. Almost 60% of those with diabetes experienced food or medication shortages during the quarantine period, which was much higher than those without diabetes. Importantly, respondents who experienced medication shortages reported a 63% higher COVID-19 infection rate. Diabetes was associated with an increased risk of self-reported personal and family member COVID-19 infection, which is mitigated by consistent use of face masks.

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  1. Version published to 10.1055/a-1468-4535
  2. ScreenIT

    SciScore for 10.1101/2020.10.07.20207282: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Xian Jiaotong University’s Institutional Review Board, and participants provided consent.
    Consent: The study was approved by the Xian Jiaotong University’s Institutional Review Board, and participants provided consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using STATA 16.1 (College Station, TX, USA).
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, the study also has limitations. First, the potential for self-selection bias is recognized in such surveys. However, it is somewhat reassuring that the prevalence of self-reported diabetes and other NCDs in our data is similar to other population surveys in China.28,29 Second, the sample was relatively younger than the national average. Therefore, findings may not be generalizable to the entire population. Third, the survey questionnaire did not ask participants to identify the specific type of diabetes that they had been diagnosed, though it is well documented that the vast majority of diabetes cases in China are T2DM.30 In conclusion, people with diabetes and their family members were found to have an increased risk of COVID-19 infection, and were more like to report shortages of food and medications during the national COVID-19 lockdown in China. Those with diabetes exhibited a variety of characteristics and behaviors which would be expected to increase both the risk of COVID-19 infection and poorer outcomes once infected. Our findings suggest that promoting public health education, better monitoring of health parameters, and stricter adherence to recommended preventive measures are particularly important among adults with diabetes. With the expanding COVID-19 pandemic, there is also an urgent need to implement measures to address anxiety management and provide practical guidance and emotional support to those at greater risk, in particular people with diabetes an...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.10.07.20207282 on medRxiv