Abstract: Diabetes Care 1 Prior Glucose-Lowering Medication Use and 30-Day Outcomes Among 64,892 Veterans With Diabetes and COVID-19 Pandora L. Wander,1,2 Elliott Lowy,1,3 Lauren A. Beste,1,2 Luis Tulloch-Palomino,1,2 Anna Korpak,1 Alexander C. Peterson,1 Steven E. Kahn,1,2 and Edward J. Boyko1,2 https://doi.org/10.2337/dc21-1351 EPIDEMIOLOGY/HEALTH SERVICES RESEARCH 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). 1 Veterans Affairs Puget Sound Health Care System, Seattle, WA 2 Department of Medicine, University of Washington, Seattle, WA 3 Department of Health Systems and Population Health, University of Washington, Seattle, WA Corresponding author: Pandora L. Wander, lwander@u.washington.edu CONCLUSIONS Received 28 June 2021 and accepted 10 September 2021 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. This article contains supplementary material online at https://doi.org/10.2337/figshare.16629652 Diabetes is a risk factor for short-term adverse outcomes from coronavirus disease 2019 (COVID-19) (1). In a recent report, we identified risk factors for adverse short- © 2021 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www. diabetesjournals.org/content/license. Diabetes Care Publish Ahead of Print, published online October 6, 2021 2 Diabetes Care Diabetes and COVID-19 Outcomes in Veterans Table 1—Characteristics of VA veterans diagnosed with diabetes and COVID-19 Count (N = 64,892) % Female sex at birth 3,872 6 Age category,..