Evaluation and management of COVID-19-related severity in people with type 2 diabetes
Wang et al.
, Evaluation and management of COVID-19-related severity in people with type 2 diabetes
, BMJ Open Diabetes Research & Care, doi:10.1136/bmjdrc-2021-002299
Retrospective 16,504 COVID-19 type 2 diabetes patients, showing lower risk of ICU admission with existing metformin use.
risk of ICU admission, 12.0% lower, RR 0.88, p = 0.005, treatment 6,504, control 10,000, Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Wang et al., 7 Sep 2021, retrospective, USA, peer-reviewed, 4 authors.
Abstract: Original research
Evaluation and management of COVID19-related severity in people with type
Bowen Wang ,1,2 Benjamin S Glicksberg,3,4 Girish N Nadkarni,4,5
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
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Received 31 March 2021
Accepted 25 August 2021
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Dr Deepak Vashishth;
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
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.
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