Article Text

Evaluation and management of COVID-19-related severity in people with type 2 diabetes
  1. Bowen Wang1,2,
  2. Benjamin S Glicksberg3,4,
  3. Girish N Nadkarni4,5,
  4. Deepak Vashishth1,2
  1. 1Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
  2. 2OptumLabs Visiting Fellow, Optum Health, Eden Prairie, Minnesota, USA
  3. 3Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  4. 4Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  5. 5Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Dr Deepak Vashishth; vashid{at}rpi.edu

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.

  • COVID-19
  • HbA1c

Data availability statement

Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from OptumLabs Data Warehouse. Restrictions apply to the availability of these data, which were used under license for this study.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from OptumLabs Data Warehouse. Restrictions apply to the availability of these data, which were used under license for this study.

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Footnotes

  • Contributors DV is the principal investigator of the study. BSG and GNN are coinvestigators. All authors contributed to study design. BW contributed to data collection and organization. Data were analyzed by BW, and interpreted by BW, BSG, GNN and DV. BW drafted the manuscript and revisions were suggested by DV, BSG, and GNN. The final version was approved by all the authors. BW will take responsibility for integrity of data analyses.

  • Funding This work was supported by the National Institutes of Health’s (NIH) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (R21AR071681).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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