Assessing the burden of diabetes mellitus in dengue patients: A systematic review and meta-analysis

Background Dengue is a rapidly expanding mosquito-borne viral disease and a growing global public health challenge. Simultaneously, the prevalence of diabetes mellitus (DM) continues to rise worldwide. DM, often referred to as a silent pandemic, is characterized by chronic inflammation, endothelial dysfunction, and impaired immune responses, mechanisms that may worsen dengue outcomes. Objectives Given this context, our study aimed to systematically synthesize evidence on the association between DM and severe dengue outcomes, especially severe dengue and dengue-related mortality. Methods PubMed, Scopus, and Embase were searched, alongside manual screening of reference lists, for English-language observational studies published between 1987 and 2025 reporting dengue outcomes in patients with and without DM. Severe dengue definitions based on both WHO 1997 and WHO 2009 classifications were considered. Screening, data extraction, and risk-of-bias assessment were performed independently by two reviewers, with disagreements resolved by consensus. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. Results A total of 27 eligible studies involving 734,123 participants met the inclusion criteria. Compared with non-diabetic patients, those with DM had significantly higher odds of severe dengue (OR: 2.66, 95% CI: 1.90-3.73) and of dengue-related mortality (OR: 3.95, 95% CI: 2.98-5.23). Conclusions DM is independently associated with severe dengue and dengue-related mortality. These findings underscore the need for early identification and close monitoring of diabetic patients in dengue-endemic settings, and for integrated management strategies addressing both infectious and non-communicable diseases. Further research is needed to elucidate the underlying mechanisms and evaluate targeted interventions in this vulnerable population.