Prior Glucose-Lowering Medication Use and 30-Day Outcomes Among 64,892 Veterans With Diabetes and COVID-19
Wander et al.
, Prior Glucose-Lowering Medication Use and 30-Day Outcomes Among 64,892 Veterans With Diabetes and COVID-19
, Diabetes Care, doi:10.2337/dc21-1351
Retrospective 64,892 veterans with diabetes in the USA, showing lower mortality with existing metformin use.
risk of death, 15.0% lower, RR 0.85, p < 0.001, treatment 29,685, control 35,207, odds ratio converted to relative risk, logistic regression, within 30 days of diagnosis, control prevalance approximated with overall prevalence.
risk of ICU admission, 1.9% lower, RR 0.98, p = 0.62, treatment 29,685, control 35,207, odds ratio converted to relative risk, logistic regression, within 30 days of diagnosis, control prevalance approximated with overall prevalence.
risk of hospitalization, 3.2% lower, RR 0.97, p = 0.09, treatment 29,685, control 35,207, odds ratio converted to relative risk, logistic regression, within 30 days of diagnosis, control prevalance approximated with overall prevalence.
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Wander et al., 6 Oct 2021, retrospective, database analysis, USA, peer-reviewed, 8 authors.
Abstract: Diabetes Care
Medication Use and 30-Day
Outcomes Among 64,892
Veterans With Diabetes and
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
EPIDEMIOLOGY/HEALTH SERVICES RESEARCH
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.
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).
Veterans Affairs Puget Sound Health Care
System, Seattle, WA
Department of Medicine, University of Washington,
Department of Health Systems and Population
Health, University of Washington, Seattle, WA
Corresponding author: Pandora L. Wander,
Received 28 June 2021 and accepted 10
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
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.
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Diabetes Care Publish Ahead of Print, published online October 6, 2021
Diabetes and COVID-19 Outcomes in Veterans
Table 1—Characteristics of VA veterans diagnosed with diabetes and COVID-19
(N = 64,892)
Female sex at birth
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