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16.02.2023 | COVID-19 | Original Research

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

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

Erschienen in: Journal of General Internal Medicine | Ausgabe 6/2023

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Abstract

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.

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Titel: Association Between Diabetes Severity and Risks of COVID-19 Infection and Outcomes
verfasst von: James S. Floyd, MD
Rod L. Walker, MS
Jennifer L. Kuntz, PhD
Susan M. Shortreed, PhD
Stephen P. Fortmann, MD
Elizabeth A. Bayliss, MD
Laura B. Harrington, PhD
Sharon Fuller, BA
Ladia H. Albertson-Junkans, MPH
John D. Powers, MS
Mi H. Lee, MPH
Lisa A. Temposky, BA
Sascha Dublin, MD
Publikationsdatum: 16.02.2023
Verlag: Springer International Publishing
Schlagwort: COVID-19
Erschienen in: Journal of General Internal Medicine / Ausgabe 6/2023
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-023-08076-9

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