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.
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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.
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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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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Wander et al., 6 Oct 2021, retrospective, database analysis, USA, peer-reviewed, 8 authors.
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,..
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