Abstract: Original research Evaluation and management of COVID19-­related severity in people with type 2 diabetes Bowen Wang ‍ ‍,1,2 Benjamin S Glicksberg,3,4 Girish N Nadkarni,4,5 Deepak Vashishth1,2 To cite: Wang B, Glicksberg BS, Nadkarni GN, et al. Evaluation and management of COVID19-­related severity in people with type 2 diabetes. BMJ Open Diab Res Care 2021;9:e002299. doi:10.1136/ bmjdrc-2021-002299 ►► Additional supplemental material is published online only. To view, please visit the journal online (http://d​ x.​doi.​ org/​10.​1136/b​ mjdrc-​2021-​ 002299). Received 31 March 2021 Accepted 25 August 2021 © Author(s) (or their employer(s)) 2021. Re-­use permitted under CC BY-­NC. No commercial re-­use. See rights and permissions. Published by BMJ. For numbered affiliations see end of article. Correspondence to Dr Deepak Vashishth; ​vashid@​rpi.e​ du ABSTRACT Introduction People with type 2 diabetes (T2D) have an increased rate of hospitalization and mortality related to COVID-19. To identify ahead of time those who are at risk of developing severe diseases and potentially in need of intensive care, we investigated the independent associations between longitudinal glycated hemoglobin (HbA1c), the impact of common medications (metformin, insulin, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and corticosteroids) and COVID-19 severity in people with T2D. Research design and methods Retrospective cohort study was conducted using deidentified claims and electronic health record data from the OptumLabs Data Warehouse across the USA between January 2017 and November 2020, including 16 504 individuals with T2D and COVID-19. A univariate model and a multivariate model were applied to evaluate the association between 2 and 3-­year HbA1c average, medication use between COVID-19 diagnosis and intensive care unit admission (if applicable), and risk of intensive care related to COVID-19. Results With covariates adjusted, the HR of longitudinal HbA1c for risk of intensive care was 1.12 (per 1% increase, p<0.001) and 1.48 (comparing group with poor (HbA1c ≥9%) and adequate glycemic control (HbA1c 6%–9%), p<0.001). The use of corticosteroids and the combined use of insulin and metformin were associated with significant reduction of intensive care risk, while ACEIs and ARBs were not associated with reduced risk of intensive care. Conclusions Two to three-­year longitudinal glycemic level is independently associated with COVID-19-­related severity in people with T2D. Here, we present a potential method to use HbA1c history, which presented a stronger association with COVID-19 severity than single-­point HbA1c, to identify in advance those more at risk of intensive care due to COVID-19 in the T2D population. The combined use of metformin and insulin and the use of corticosteroids might be significant to prevent patients with T2D from becoming critically ill from COVID-19.