Abstract: Revised: 31 August 2022 Accepted: 10 September 2022 DOI: 10.1111/dom.14872 RESEARCH LETTER Ethnicity and risks of severe COVID-19 outcomes associated with glucose-lowering medications: A cohort study Francesco Zaccardi PhD 1 | Pui San Tan PhD 2 4 | Ash Kieran Clift MBBS Baiju R. Shah PhD 2 Martina Patone PhD | Simon J. Griffin DM 6,7 Kamlesh Khunti PhD 1 | Carol Coupland PhD 2,3 2,5 | 2 | Defne Saatci MBBS | | Hajira Dambha-Miller PhD 8 | | Julia Hippisley-Cox FRCP 2 1 Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK 3 Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK 4 Department of Medicine, University of Toronto; Division of Endocrinology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada 5 Cancer Research UK Oxford Centre, University of Oxford, Oxford, UK 6 Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK 7 MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK 8 Primary Care Research Centre, University of Southampton, Southampton, UK Correspondence Francesco Zaccardi, Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital Gwendolen Road, Leicester, LE5 4PW, UK. Email: frazac@fastwebnet.it Funding information National Insitute for Health and Care Research (NIHR), Grant/Award Number: COV0130 /MR/V027778/1; UK Research and Innovation; Academic Clinical Lecturer; Leicester Biomedical Research Centre (BRC), Grant/Award Number: NIHR200171; Applied Research Collaboration East Midlands (ARC EM); Cancer Research UK Oxford Centre, and the Oxford Wellcome Institutional, Grant/Award Number: 204826/Z/16/Z; National Institute for Health Research, Oxford, John Fell Oxford University Press Research Fund, Cancer Research UK, Grant/Award Number: C5255/A18085; Clinical Research Fellowship from Cancer Research UK, Grant/Award Number: C2195/A31310; MRC Epidemiology Unit programme, Grant/Award Number: MC_UU_12015/4 1 | I N T RO DU CT I O N [metformin (MF), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), sulphonylurea].5 During the early phases of the COVID-19 pandemic, diabetes became Alongside the role of diabetes, multiple large observational stud- associated with a poorer prognosis,1 with an approximately three-fold ies also showed higher risks of COVID-19-related hospitalization, increased risk of a COVID-19 death in those with diabetes compared intensive care unit admission and death in people from ethnic minor- with those without.2,3 In an effort to understand this association, ity populations.6,7 there was an increasing interest in the role of glucose-lowering medi- As type 2 diabetes is more prevalent in ethnic minority cations on the risk of COVID-19 outcomes, given their pharmacologi- populations—particularly South Asians—determining the risk of COVID- cal differences and potential direct effect on shared immunometabolic 19 outcomes in relation to different glucose-lowering therapies has impli- pathways4: the available evidence would suggest small absolute cations for both patients and health care professionals.8 We therefore increased rates of COVID-19 mortality with some dipeptidyl pepti- designed a cohort study within the QResearch UK nationwide..