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Prior Glucose-Lowering Medication Use and 30-Day Outcomes Among 64,892 Veterans With Diabetes and COVID-19.
Wander, Pandora L; Lowy, Elliott; Beste, Lauren A; Tulloch-Palomino, Luis; Korpak, Anna; Peterson, Alexander C; Kahn, Steven E; Boyko, Edward J.
  • Wander PL; Veterans Affairs Puget Sound Health Care System, Seattle, WA lwander@u.washington.edu.
  • Lowy E; Department of Medicine, University of Washington, Seattle, WA.
  • Beste LA; Veterans Affairs Puget Sound Health Care System, Seattle, WA.
  • Tulloch-Palomino L; Department of Health Systems and Population Health, University of Washington, Seattle, WA.
  • Korpak A; Veterans Affairs Puget Sound Health Care System, Seattle, WA.
  • Peterson AC; Department of Medicine, University of Washington, Seattle, WA.
  • Kahn SE; Veterans Affairs Puget Sound Health Care System, Seattle, WA.
  • Boyko EJ; Department of Medicine, University of Washington, Seattle, WA.
Diabetes Care ; 44(12): 2708-2713, 2021 12.
Article in English | MEDLINE | ID: covidwho-1456244
ABSTRACT

OBJECTIVE:

To identify preinfection risk factors for adverse outcomes among veterans with diabetes and coronavirus disease 2019 (COVID-19) infection. RESEARCH DESIGN AND

METHODS:

We identified all Veterans Health Administration patients with diabetes and one or more positive nasal swab(s) for severe acute respiratory syndrome coronavirus 2 (1 March 2020-10 March 2021) (n = 64,892). We examined associations of HbA1c and glucose-lowering medication use with hospitalization, intensive care unit (ICU) admission, and mortality at 30 days using logistic regression models and during 4.4 months of follow-up (range <1-13.1) using proportional hazards models.

RESULTS:

Compared with HbA1c <7.0%, HbA1c ≥9.0% was associated with higher odds of hospitalization, ICU admission, and death at 30 days (odds ratio [OR] 1.27 [95% CI 1.19-1.35], 1.28 [95% CI 1.15-1.42], 1.30 [95% CI 1.17-1.44], respectively) as well as higher risk of death over 4.4 months (hazard ratio [HR] 1.22 [95% CI 1.12-1.32]). Insulin use was associated with higher odds of hospitalization, ICU admission, and death (OR 1.12 [95% CI 1.07-1.18], 1.12 [95% CI 1.04-1.22], and 1.18 [95% CI 1.09-1.27], respectively) and higher risk of death (HR 1.12 [95% CI 1.07-1.18]). Sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor agonist (GLP1-RA), or angiotensin receptor blocker use were associated with lower odds of hospitalization (OR 0.92 [95% CI 0.85-0.99], 0.88 [95% CI 0.81-0.96], and 0.94 [95% CI 0.89-0.99], respectively). Metformin and SGLT2i use were associated with lower odds (OR 0.84 [95% CI 0.78-0.91], 0.82 [95% CI 0.72-0.94], respectively) and risk of death (HR 0.84 [95% CI 0.79-0.89], 0.82 [95% CI 0.74-0.92], respectively).

CONCLUSIONS:

Among veterans with diabetes and COVID-19, higher HbA1c and insulin use were directly associated with adverse outcomes, while use of a GLP1-RA, metformin, and SGLT2i was inversely associated.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Diabetes Mellitus / COVID-19 Type of study: Cohort study / Prognostic study Limits: Humans Language: English Journal: Diabetes Care Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Diabetes Mellitus / COVID-19 Type of study: Cohort study / Prognostic study Limits: Humans Language: English Journal: Diabetes Care Year: 2021 Document Type: Article