Journal Article

Association Between Diabetes Severity and Risks of COVID-19 Infection and Outcomes

Powers, John D., Bayliss, Elizabeth A., Floyd, James S., Fortmann, Stephen P., Temposky, Lisa A., Dublin, Sascha, Lee, Mi H., Harrington, Laura B., Walker, Rod L., Fuller, Sharon, Albertson-Junkans, Ladia H., Kuntz, Jennifer L., Shortreed, Susan M.

2023

Overview

Background Little is known about whether diabetes increases the risk of COVID-19 infection and whether measures of diabetes severity are related to COVID-19 outcomes. Objective Investigate diabetes severity measures as potential risk factors for COVID-19 infection and COVID-19 outcomes. Design, Participants, Measures In integrated healthcare systems in Colorado, Oregon, and Washington, we identified a cohort of adults on February 29, 2020 ( n  = 1,086,918) and conducted follow-up through February 28, 2021. Electronic health data and death certificates were used to identify markers of diabetes severity, covariates, and outcomes. Outcomes were COVID-19 infection (positive nucleic acid antigen test, COVID-19 hospitalization, or COVID-19 death) and severe COVID-19 (invasive mechanical ventilation or COVID-19 death). Individuals with diabetes ( n  = 142,340) and categories of diabetes severity measures were compared with a referent group with no diabetes ( n  = 944,578), adjusting for demographic variables, neighborhood deprivation index, body mass index, and comorbidities. Results Of 30,935 patients with COVID-19 infection, 996 met the criteria for severe COVID-19. Type 1 (odds ratio [OR] 1.41, 95% CI 1.27–1.57) and type 2 diabetes (OR 1.27, 95% CI 1.23–1.31) were associated with increased risk of COVID-19 infection. Insulin treatment was associated with greater COVID-19 infection risk (OR 1.43, 95% CI 1.34–1.52) than treatment with non-insulin drugs (OR 1.26, 95% 1.20–1.33) or no treatment (OR 1.24; 1.18–1.29). The relationship between glycemic control and COVID-19 infection risk was dose-dependent: from an OR of 1.21 (95% CI 1.15–1.26) for hemoglobin A1c (HbA1c) < 7% to an OR of 1.62 (95% CI 1.51–1.75) for HbA1c ≥ 9%. Risk factors for severe COVID-19 were type 1 diabetes (OR 2.87; 95% CI 1.99–4.15), type 2 diabetes (OR 1.80; 95% CI 1.55–2.09), insulin treatment (OR 2.65; 95% CI 2.13–3.28), and HbA1c ≥ 9% (OR 2.61; 95% CI 1.94–3.52). Conclusions Diabetes and greater diabetes severity were associated with increased risks of COVID-19 infection and worse COVID-19 outcomes.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Antigens / Body mass / Body mass index / Body size / Comorbidity / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - epidemiology / Death / Demographic variables / Diabetes / Diabetes mellitus / Diabetes mellitus (insulin dependent) / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 1 - complications / Diabetes Mellitus, Type 2 - drug therapy / Glycated Hemoglobin / Health risks / Hemoglobin / Humans / Infections / Insulin / Internal Medicine / Mechanical ventilation / Medicine / Medicine & Public Health / Mortality / Nucleic acids / Original Research / Risk Factors / Risk management