Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland

DOI record: { "DOI": "10.1136/bmjdrc-2022-002774", "ISSN": [ "2052-4897" ], "URL": "http://dx.doi.org/10.1136/bmjdrc-2022-002774", "abstract": "<jats:sec><jats:title>Objective</jats:title><jats:p>To identify the demographic and clinical characteristics associated with adverse COVID-19 outcomes across a 12-month period in 2020 and 2021.</jats:p></jats:sec><jats:sec><jats:title>Research design and methods</jats:title><jats:p>We conducted a retrospective cohort study using electronic health records from five academic health systems in Pennsylvania and Maryland, including patients with COVID-19 with type 2 diabetes or at risk of type 2 diabetes. Patients were classified based on 30-day outcomes: (1) no hospitalization; (2) hospitalization only; or (3) a composite measure including admission to the intensive care unit (ICU), intubation, or death. Analyses were conducted in patients with type 2 diabetes and patients at risk of type 2 diabetes separately.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included 15 725 patients with COVID-19 diagnoses between March 2020 and February 2021. Older age and higher Charlson Comorbidity Index scores were associated with higher odds of adverse outcomes, while COVID-19 diagnoses later in the study period were associated with lower odds of severe outcomes. In patients with type 2 diabetes, individuals on insulin treatment had higher odds for ICU/intubation/death (OR=1.59, 95% CI 1.27 to 1.99), whereas those on metformin had lower odds (OR=0.56, 95% CI 0.45 to 0.71). Compared with non-Hispanic White patients, Hispanic patients had higher odds of hospitalization in patients with type 2 diabetes (OR=1.73, 95% CI 1.36 to 2.19) or at risk of type 2 diabetes (OR=1.77, 95% CI 1.43 to 2.18.)</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Adults who were older, in racial minority groups, had multiple chronic conditions or were on insulin treatment had higher risks for severe COVID-19 outcomes. This study reinforced the urgency of preventing COVID-19 and its complications in vulnerable populations.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02788903\">NCT02788903</jats:ext-link>.</jats:p></jats:sec>", "alternative-id": [ "10.1136/bmjdrc-2022-002774" ], "author": [ { "ORCID": "http://orcid.org/0000-0002-5738-0652", "affiliation": [], "authenticated-orcid": false, "family": "Yeh", "given": "Hsin-Chieh", "sequence": "first" }, { "affiliation": [], "family": "Kraschnewski", "given": "Jennifer L", "sequence": "additional" }, { "affiliation": [], "family": "Kong", "given": "Lan", "sequence": "additional" }, { "affiliation": [], "family": "Lehman", "given": "Erik B", "sequence": "additional" }, { "affiliation": [], "family": "Heilbrunn", "given": "Emily S", "sequence": "additional" }, { "affiliation": [], "family": "Williams", "given": "Pamela", "sequence": "additional" }, { "affiliation": [], "family": "Poger", "given": "Jennifer M", "sequence": "additional" }, { "affiliation": [], "family": "Francis", "given": "Erica", "sequence": "additional" }, { "affiliation": [], "family": "Bryce", "given": "Cindy L", "sequence": "additional" } ], "clinical-trial-number": [ { "clinical-trial-number": "nct02788903", "registry": "10.18810/clinical-trials-gov" } ], "container-title": "BMJ Open Diabetes Research &amp; 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Patient Centered Outcomes Research Institute . The National patient-centered clinical research network. accessed January 7, 2019. Available: http://www.pcornet.org/resource-center/pcornet-common-data-model/" }, { "DOI": "10.2196/12054", "article-title": "A patient-centered path to address diabetes: protocol for a study on the impact of obesity counseling", "author": "Kraschnewski", "doi-asserted-by": "crossref", "journal-title": "JMIR Res Protoc", "key": "2022060909200758000_10.3.e002774.12", "volume": "8", "year": "2019" }, { "DOI": "10.1016/0021-9681(87)90171-8", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.13" }, { "article-title": "Charlson Comorbidity Index: ICD-9 Update and ICD-10 Translation", "author": "Glasheen", "first-page": "188", "journal-title": "Am Health Drug Benefits", "key": "2022060909200758000_10.3.e002774.14", "volume": "12", "year": "2019" }, { "DOI": "10.2337/dc20-2260", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.15" }, { "DOI": "10.1002/jmv.26227", "article-title": "Impaired glucose metabolism in patients with diabetes, prediabetes, and obesity is associated with severe COVID-19", "author": "Smith", "doi-asserted-by": "crossref", "first-page": "409", "journal-title": "J Med Virol", "key": "2022060909200758000_10.3.e002774.16", "volume": "93", "year": "2021" }, { "DOI": "10.1001/jama.2020.15301", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.17" }, { "DOI": "10.1016/j.cmet.2020.04.021", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.18" }, { "DOI": "10.1001/jamainternmed.2021.4945", "article-title": "Age at diagnosis of diabetes by race and ethnicity in the United States from 2011 to 2018", "author": "Wang", "doi-asserted-by": "crossref", "first-page": "1537", "journal-title": "JAMA Intern Med", "key": "2022060909200758000_10.3.e002774.19", "volume": "181", "year": "2021" }, { "DOI": "10.1001/jama.2021.9883", "article-title": "Trends in prevalence of diabetes and control of risk factors in diabetes among US adults, 1999-2018", "author": "Wang", "doi-asserted-by": "crossref", "first-page": "704", "journal-title": "JAMA", "key": "2022060909200758000_10.3.e002774.20", "volume": "326", "year": "2021" }, { "DOI": "10.1001/jamanetworkopen.2020.21892", "article-title": "Racial disparities in incidence and outcomes among patients with COVID-19", "author": "Muñoz-Price", "doi-asserted-by": "crossref", "journal-title": "JAMA Netw Open", "key": "2022060909200758000_10.3.e002774.21", "volume": "3", "year": "2020" }, { "DOI": "10.1186/s12889-021-11431-2", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.22" }, { "DOI": "10.1007/s13300-021-01110-1", "article-title": "Risk factors associated with COVID-19 hospitalization and mortality: a large Claims-Based analysis among people with type 2 diabetes mellitus in the United States", "author": "Boye", "doi-asserted-by": "crossref", "first-page": "2223", "journal-title": "Diabetes Ther", "key": "2022060909200758000_10.3.e002774.23", "volume": "12", "year": "2021" }, { "DOI": "10.1016/S2213-8587(21)00050-4", "article-title": "Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England", "author": "Khunti", "doi-asserted-by": "crossref", "first-page": "293", "journal-title": "Lancet Diabetes Endocrinol", "key": "2022060909200758000_10.3.e002774.24", "volume": "9", "year": "2021" }, { "DOI": "10.2337/dc21-1351", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.25" }, { "DOI": "10.1016/j.metabol.2022.155196", "article-title": "Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: a meta-analysis", "author": "Nguyen", "doi-asserted-by": "crossref", "first-page": "155196", "journal-title": "Metabolism", "key": "2022060909200758000_10.3.e002774.26", "volume": "131", "year": "2022" }, { "DOI": "10.1056/NEJMoa2015432", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.27" }, { "DOI": "10.1038/srep36222", "article-title": "Metformin uniquely prevents thrombosis by inhibiting platelet activation and mtDNA release", "author": "Xin", "doi-asserted-by": "crossref", "journal-title": "Sci Rep", "key": "2022060909200758000_10.3.e002774.28", "volume": "6", "year": "2016" }, { "DOI": "10.1161/CIRCRESAHA.116.308445", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.29" }, { "DOI": "10.1097/ALN.0000000000002619", "article-title": "Neutrophil extracellular traps are elevated in patients with pneumonia-related acute respiratory distress syndrome", "author": "Bendib", "doi-asserted-by": "crossref", "first-page": "581", "journal-title": "Anesthesiology", "key": "2022060909200758000_10.3.e002774.30", "volume": "130", "year": "2019" }, { "DOI": "10.1172/jci.insight.138999", "doi-asserted-by": "crossref", "key": "2022060909200758000_10.3.e002774.31", "unstructured": "Zuo Y , Yalavarthi S , Shi H , et al . Neutrophil extracellular traps in COVID-19. JCI Insight 2020;5:e138999.doi:10.1172/jci.insight.138999" }, { "DOI": "10.1128/AAC.03659-14", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.32" }, { "DOI": "10.1101/2020.06.24.150326", "doi-asserted-by": "crossref", "key": "2022060909200758000_10.3.e002774.33", "unstructured": "Garcia G , Sharma A , Ramaiah A . Antiviral drug screen of kinase inhibitors identifies cellular signaling pathways critical for SARS-CoV-2 replication. bioRxiv 2020." }, { "DOI": "10.2337/db21-0385", "article-title": "Diabetes, drug treatment, and mortality in COVID-19: a multinational retrospective cohort study", "author": "Nyland", "doi-asserted-by": "crossref", "journal-title": "Diabetes", "key": "2022060909200758000_10.3.e002774.34", "volume": "70", "year": "2021" }, { "DOI": "10.2337/dc21-1351", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.35" }, { "DOI": "10.2337/figshare.19119302", "doi-asserted-by": "crossref", "key": "2022060909200758000_10.3.e002774.36", "unstructured": "Wong R , Hall M , Vaddavalli R . Glycemic control and clinical outcomes in US. patients with COVID-19: data from the National COVID cohort collaborative (N3C) database. Diabetes Care 2022;24:dc212186." }, { "DOI": "10.1002/dmrr.3398", "article-title": "Haemoglobin A1c is a predictor of COVID-19 severity in patients with diabetes", "author": "Merzon", "doi-asserted-by": "crossref", "journal-title": "Diabetes Metab Res Rev", "key": "2022060909200758000_10.3.e002774.37", "volume": "37", "year": "2021" }, { "DOI": "10.1016/S2213-8587(20)30271-0", "article-title": "Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study", "author": "Holman", "doi-asserted-by": "crossref", "first-page": "823", "journal-title": "Lancet Diabetes Endocrinol", "key": "2022060909200758000_10.3.e002774.38", "volume": "8", "year": "2020" }, { "DOI": "10.1136/bmjopen-2021-052777", "doi-asserted-by": "publisher", "key": "2022060909200758000_10.3.e002774.39" } ], "reference-count": 39, "references-count": 39, "relation": {}, "resource": { "primary": { "URL": "https://drc.bmj.com/lookup/doi/10.1136/bmjdrc-2022-002774" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "Endocrinology, Diabetes and Metabolism" ], "subtitle": [], "title": "Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland", "type": "journal-article", "update-policy": "http://dx.doi.org/10.1136/crossmarkpolicy", "volume": "10" }