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 Table of Contents  
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 350-356

Bibliometric analysis of diabetes research in relation to the COVID-19 pandemic

1 CSIR-National Institute of Science, Technology, and Development Studies, New Delhi, India
2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Endocrinology and Diabetes Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission10-Mar-2021
Date of Decision27-May-2021
Date of Acceptance30-Apr-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Prof. Devi Dayal
Endocrinology and Diabetes Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JOD.JOD_30_21

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Background: Diabetes is a common co-morbid condition that influences morbidity and mortality in patients with COVID-19 and has been a focus of intense research. However, a systematic assessment of global diabetes research concerning COVID-19 is unavailable. Aim: We aimed to provide a bibliometric assessment of research output on diabetes concerning the COVID-19 pandemic. Materials and Methods: Publications on diabetes in relation to COVID-19 were retrieved from the Scopus database and analyzed using appropriate bibliometric indicators. Results: The publications indexed till January 6, 2021 numbered 762. The share of the top 10 of the 82 countries was 90.6%. The USA, China, India, Italy, and the UK were the most productive countries, with publication share ranging from 11.4% to 17.8%. Brazil, China, Germany, Australia, France, and India registered higher publication impact. The average citations per paper were 7.3, and 19.4% of the publications were funded. The share of publications on type 2 diabetes, type 1 diabetes, and gestational diabetes was 23.2%, 16.5%, and 4.1%, respectively. Diabetic complications, clinical studies, and epidemiology were the most researched aspects of diabetes concerning COVID-19, with 47.9%, 23.3%, and 14.0% share, respectively. Publications on pathophysiology numbered only 93 (12.2%). The most productive organizations were Tongji Medical College, China, Huazhong University, China, Postgraduate Institute of Medical Education and Research, India, and INSERM, France. Obesity and Cholesterol Foundation, India, Imperial College, UK, and The Central Hospital of Wuhan, China were the most impactful organizations. R. Pal, A. Ceriello, and B. Cariou were the most productive authors, whereas A. Misra, R. Gupta, and A.K. Singh were the most impactful. The most active journals were Diabetes Research and Clinical Practice, Diabetes and Metabolic Syndrome: Clinical Research and Reviews, Journal of Diabetes Science and Technology, and Diabetes Care. Conclusion: Extensive high-quality research has been conducted on diabetes in relation to the COVID-19 pandemic in developed and developing countries. There is a need to focus on pathophysiological studies to elucidate further the underlying mechanisms that predispose COVID-19-affected diabetes patients to severe disease and death. Our scientometric assessment may help understand the research gaps and guide future research in this field.

Keywords: Bibliometrics, COVID-19, diabetes, global publications

How to cite this article:
Gupta BM, Pal R, Rohilla L, Dayal D. Bibliometric analysis of diabetes research in relation to the COVID-19 pandemic. J Diabetol 2021;12:350-6

How to cite this URL:
Gupta BM, Pal R, Rohilla L, Dayal D. Bibliometric analysis of diabetes research in relation to the COVID-19 pandemic. J Diabetol [serial online] 2021 [cited 2021 Nov 30];12:350-6. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/3/350/327307

  Introduction Top

Coronavirus disease 2019 (COVID-19) is associated with worse outcomes in patients with pre-existing conditions such as hypertension, obesity, and diabetes mellitus.[1] In people with diabetes, there is no definitive increase in the risk of contracting COVID-19, but the risk for severity and mortality related to COVID-19 increases significantly.[2] When hospitalized for COVID-19, people with diabetes are 2–3 times more likely to die compared with those without diabetes.[2] However, the exact reasons and pathophysiology underlying the greater risk of severe infection and death from COVID-19 in people with diabetes are not fully understood.

Several other aspects of diabetes in relation to COVID-19 are still poorly understood. Researchers have attempted to explain the observed association between diabetes and COVID-19, attributing it to chronic inflammation, impaired innate and humoral immune response, and increased coagulation activity in patients with poor metabolic control.[3] However, the causes of acute metabolic complications such as diabetic ketoacidosis following COVID-19 in patients with reasonable glycemic control remain unclear, even though direct pancreatic β-cell injury leading to impaired insulin secretion has been postulated.[3] The mechanism underlying the precipitation of onset of type 1 diabetes (T1D) after coronavirus exposure is also not precisely known. There are scarce data on the specific considerations in managing COVID-19 in children with diabetes, and guidelines are primarily based on experiences during the previous epidemics.[4],[5] Bibliometric studies help scientists to map the research activities and identify hotspots and research trends.[6] Several recent studies have mapped the literature on COVID-19 in general and concerning other aspects such as mental health, neurological disease, children, and trauma and orthopedics.[7],[8],[9],[10] However, a scientometric assessment of literature on COVID-19 concerning diabetes is not available so far. Therefore, we planned the current bibliometric study to provide an evaluation of diabetes research in relation to the COVID-19 pandemic.

  Materials and Methods Top

The data on publications were retrieved from the Scopus database (http://www.scopus.com) using the following search string:

TITLE (“COVID 19” OR “2019 novel coronavirus” OR “coronavirus 2019” OR “coronavirus disease 2019” OR “2019-novel CoV” OR “2019 ncov” OR covid 2019 OR covid19 OR “corona virus 2019” OR ncov-2019 OR ncov2019 OR “nCoV 2019” OR 2019-ncov OR covid-19 OR “Severe acute respiratory syndrome coronavirus 2” OR “SARS-CoV-2”) AND TITLE (Diabet*)

The search strategy was similar to our previous bibliometric studies on diabetes.[11],[12],[13] The retrieved publications were analyzed by type and source, countries, institutions and authors, collaborations, funding sources, significant keywords, the media of research communication, and high-impact publications.

The number of publications was taken as the quantitative indicator of the research productivity. We used the complete counting technique, wherein every contributing author or organization covered in multiple authorship papers is fully counted and thus receives equal credit. The qualitative indicators included citations per paper (CPP), relative citation index (RCI), and h-index (HI). The CPP is the total number of citations divided by the total number of papers. The RCI, which indicates the influence of a publication, is obtained by dividing the number of citations by the average number of citations that an article usually receives in that particular field. H-index, or Hirsch index, is defined as the maximum value of h such that the given author/journal has published h papers that have each been cited at least h times. If a paper accumulated more than 50 citations since its publication, it was considered a highly cited publication (HCP). We also utilized VOSviewer software to analyze and visualize the networks of co-authorship relations between authors, countries, institutions, and co-occurrence relations between keywords. The time period evaluated was from December 2019, when the first result was published, to January 6, 2021. Citations were counted from the date of publication till January 6, 2021.

Ethical considerations

This bibliometric study used secondary data that do not require approval from the Ethics Committee for research on humans. However, we followed the ethical principles recommended for analysis of this nature through respecting ideas and citations and referencing authors and their publications.

  Results Top

The total number of publications was 762. A majority of publications (420, 55.1%) appeared as original articles, 129 (16.9%) as letters, 88 (11.5%) as reviews, 81 (10.6%) as notes, and the rest (0.6–4.2%) as editorials, short surveys, and errata. Only 148 (19.4%) publications received financial support from more than 100 funding agencies. The major funding agencies were: National Natural Science Foundation of China (23 papers), Eli Lilly and Company (18 papers), Novo Nordisk (16 papers), Sanofi (13 papers), National Institute of Diabetes and Digestive and Kidney Diseases (11 papers), etc. The average CPP of all publications was 7.3; however, the funded publications received more citations (average CPP 12.6).

Distribution of publications by diabetes type, subject, focus areas, and age

The share of publications on type 2 diabetes (T2D), T1D, and gestational diabetes mellitus (GDM) was 23.2% (177 papers), 16.5% (126 papers), and 4.1% (31 papers), respectively. The diabetes type was unspecified in the rest of the publications. The average CPP for T2D, T1D, and GDM publications was 14.3, 11.6, and 2.8, respectively.

The broad subject headings of COVID-related diabetes research were medicine (718 publications, 94.2%), biochemistry, genetics and molecular biology (277 papers, 36.3%), pharmacology, toxicology, and pharmaceutics (24 papers, 3.1%), and immunology and microbiology (19 papers, 2.5%). Biochemistry, genetics and molecular biology registered the highest CPP (9.5), while pharmacology, toxicology, and pharmaceutics recorded the least CPP (1.0).

The share of publications on diabetes complications, clinical spectrum, epidemiology, pathophysiology, and treatment outcomes was 47.9% (365 papers), 23.3% (178 articles), 14.0% (107 articles), 12.2% (93 papers), and 3.3% (25 papers), respectively. The pathophysiology studies registered the highest CPP of 13.7, followed by clinical studies (11.7), epidemiology (11.7), diabetes complications, and treatment outcome (10.3 each).

Respectively, 25.2% (192 papers), 13.1% (100 papers), 11.9% (91 papers), 4.4% (34 papers), and 4.2% (32 papers) publications involved adults, middle-aged, elderly, adolescents, and children. Publications on the elderly group had the highest citation impact (CPP 15.93), followed by the middle-aged (14.0) and adults (13.3).

Top countries and their collaborations

Eighty-two countries unevenly participated in the research; 64 published 1–10 papers, 7 published 11–20 papers, 6 published 21–50 papers, 3 published 51–100 papers, and 2 published 101–136 papers. The top 12 countries contributed 90.7% (691 papers) to the global publication output [Table 1]. The leading countries were the USA, China, India, Italy, and the UK. Brazil, China, Germany, Australia, France, and India registered RCI above the global average of 1.3. The average number of international collaborative publications (ICPs) among the top 12 countries was 19.6 (34.1%, range 18.1–57.1%) [Table 1]. The USA, Italy, and the UK showed the largest number of collaborative linkages (63, 54, and 51 linkages, respectively) with 9–11 other countries [Supplementary Table 1]. Countries with the least collaborative links (6, 23, and 25) with 2–10 countries were Iran, Brazil, and India. Among country–country collaborations, USA–Italy, USA–China, China–UK, USA–India, and USA–UK registered higher collaborative associations than other country-pairs [Supplementary Table 1].
Table 1: Most productive countries in diabetes research in relation to the COVID-19 pandemic

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Supplementary Table 1: Collaborative ties among the top countries in the COVID-diabetes research

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Most productive and impactful organizations

Of the 325 organizations that participated in the research, 272 published 1–5 papers each, 41 published 6–10 papers each, 11 published 11–20 articles each, and one published 26 papers. The top 30 organizations contributed 7–26 publications each; their combined share was 41.9% (320 publications). The top eight most productive and most impactful organizations are shown in [Table 2].
Table 2: Scientometric profile of the top 8 most productive and top 8 most impactful organizations

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Collaboration between organizations

All the top 30 research organizations except one had one-to-one collaborative linkages varying from 1 to 58. Nine organizations were from France, five each from China and UK, three from Italy, two each from India, Iran, and Brazil, and one each from Norway and the USA. The INSERM, France, Tongji Medical College, China, and Huazhong University of Science and Technology, China showed the largest number of collaborative ties (60, 58, and 58 linkages, respectively). At the organization to the organization level, Tongji Medical College, China, and Huazhong University of Science and Technology, China registered the highest number of collaborative linkages at 26, followed by INSERM, France and CNRS, France (10 links) [Supplementary Table 2].
Supplementary Table 2: The extent of collaborative linkages among top 30 research organizations

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Top authors and their collaborations

Four hundred ninety-eight authors unevenly participated in the research; only 2 published 11 papers each, whereas 14 published 6–10 papers each, and the rest 482 authors published only 1–5 papers each. Of the top 30 authors, 10 were from France, 7 from Italy, 6 from India, 4 from the UK, and 1 each from China, Norway, and South Korea. [Table 3] lists the eight most productive and eight most impactful authors.
Table 3: Scientometric profile of the most productive and the most impactful authors in diabetes research concerning COVID-19

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Twenty-seven of the top 30 authors forged collaborations varying from 1 to 45: nine were from France, five each from China and UK, three from Italy, two each from India, Iran, and Brazil, and one each from Norway and the USA. L. Potier, B. Cariou, and S. Hadjadj showed the most extensive collaborative links numbering 45, 42, and 42, respectively [Supplementary Table 3].
Supplementary Table 3: Collaborative linkages among the top 30 authors in diabetes research concerning COVID-19

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Most productive journals

All the 762 publications appeared in 170 journals; 143 journals published 1–5 papers each, 17 published 6–10 papers each, 6 published 11–20 papers each, 2 each published 21–50 and 51–93 papers. The 30 most productive journals published 60.8% of the documents and received 64.3% of the citations. [Table 4] lists the most productive journals.
Table 4: Top journals that published diabetes research in relation to COVID-19

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Characteristics of HCPs

Only 24 (3.1%) were HCPs. These accumulated 3448 citations averaging 143.6 CPP (range 52–883 CPP). The citations of 21 HCPs ranged between 50 and 200, whereas the other three were cited between 200 and 883 times. The majority (16, 66.6%) of the HCPs were collaborative publications. China and India collaborated in seven papers each, the USA and Italy in four papers each, Australia, Brazil, France, Singapore, and Switzerland in two papers each, and Bangladesh, Belgium, Germany, Greece, Indonesia, the Netherlands, Norway, and Spain in one paper each. The HCPs belonged to 230 authors and 125 organizations. Eleven were published as original articles, five as reviews, and four each as letters and notes [Supplementary Table 4]. Of the 13 journals that published 24 HCPs, Diabetes Research and Clinical Practice and Diabetes and Metabolic Syndrome: Clinical Research and Reviews published five papers each, whereas Diabetes Care, Diabetes/Metabolism Research and Reviews, and The Lancet Diabetes and Endocrinology published two articles each.
Supplementary Table 4: List of highly cited publications in diabetes research related to COVID-19

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  Discussion Top

The coronavirus disease tends to be more severe and fatal in individuals with advancing age and underlying comorbidities.[1],[2] Diabetes mellitus has emerged as distinctive comorbidity that is associated with severe disease, increased risk of acute respiratory distress syndrome, intensive care unit admission, and death from COVID-19.[14],[15],[16],[17] Although much remains speculative, a dysregulated immune system and an increased predisposition to develop cytokine storm in patients with diabetes mellitus have been implicated as the major underlying pathophysiological mechanisms.[1],[2],[15],[18]

The association between diabetes and COVID-19 has been a topic of much interest and has been thoroughly investigated upon by researchers all over the globe. In this bibliometric analysis, we found that over 1 year, as many as 762 manuscripts pertaining to diabetes and COVID-19 have been published. Most of the publications catered to T2D; however, of late, more and more data with regard to T1D and COVID-19 have come to the forefront.[19] Recent data suggest that patients with T1D are also at an increased risk of in-hospital mortality with COVID-19, the risk being higher in T1D than in T2D (odds ratio 3.51 vs. 2.02).[2] Besides, optimum management of T1D would have been difficult during the period of lockdown that has been reflected in a few recently published studies.[19],[20],[21]

The bulk of the publications pertaining to diabetes mellitus and COVID-19 were contributed by the USA, China, India, Italy, and the UK. Not surprisingly, to date, most of these countries had been worse affected by COVID-19. The significant contribution by China and India is also a testimony to the fact that these two neighboring nations also happen to be the diabetes capitals of the world.[22] As per the publications’ share, most of the manuscripts catered to diabetes complications, with the limited emphasis being laid on pathophysiology and treatment outcomes. In the absence of any robust treatment against COVID-19, multiple pre-existing drugs have been repurposed for the same. Likewise, certain anti-diabetic drugs and drugs more commonly used in patients with COVID-19, namely statins, have shown promising results. Although data are limited, a meta-analysis of observational studies has shown that the use of metformin, dipeptidyl peptidase-4 inhibitors, and statins is associated with improved clinical outcomes in COVID-19.[23],[24],[25] However, the data need to be substantiated in large-scale randomized clinical trials before generalized recommendations can be made. In addition, although hydroxychloroquine had gained much attention in the early part of the pandemic as the drug was found to inhibit SARS-CoV-2 in-vitro, the drug has not been found to improve clinical outcomes in randomized controlled trials.[26],[27] However, considering the fact that hydroxychloroquine has been found to be beneficial in T2D patients as a third-line drug after metformin and sulfonylureas,[28] the drug did incite some curiosity among researchers regarding its potential role in COVID-19 patients with underlying diabetes mellitus.[29],[30]

The challenge imposed by the COVID-19 pandemic specifically on patients with diabetes mellitus has been aptly accepted by researchers worldwide. Much evidence concerning the two waging pandemics (COVID-19 and diabetes mellitus) has been unearthed; nevertheless, more needs to be explored, especially pathophysiological considerations and treatment outcomes in COVID-19 patients with coexisting diabetes mellitus.

Limitations of the study

A major limitation of our bibliometric analysis was the use of a single database. Hence, all the publications concerning COVID-19 and diabetes may not have been retrieved. We chose the Scopus database as it provides much more extensive content coverage and search analysis tools when compared with other medical databases such as PubMed and Web of Science. Some authors suggest a simultaneous search in all the major medical databases, which may marginally improve the literature yield. Despite the limitation, our study was able to identify the major contributors to diabetes research in relation to COVID-19 and provides a framework for professional bodies, researchers, and policymakers to pursue the identified gaps for future research.

In conclusion, our study shows that substantial high-quality research has been conducted on diabetes in relation to the COVID-19 pandemic worldwide. The major contributing countries were the USA, China, India, Italy, and the UK; these were either those worse affected by the COVID-19 pandemic or having a high prevalence of diabetes in their populations. The primary focus areas of COVID-related diabetes research were the clinical spectrum, epidemiology, and diabetic complications; there is a need to further research the precise pathophysiological mechanisms behind the predisposition of diabetes patients to severe disease and death.

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Conflicts of interest

There are no conflicts of interest.

Contributors’ list

B. M. G.: concept and design of study, and acquisition, analysis, and interpretation of data; R. P.: manuscript preparation; L. R.: intellectual inputs and revision of manuscript; D. D.: manuscript preparation and critical revision for important intellectual content. All authors approved the final version of the manuscript.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]


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