Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19
Introduction Risk factors and mediators of associations of diabetes with COVID-19 outcomes are unclear.Research design and methods We identified all veterans receiving Department of Veterans Affairs healthcare with ≥1 positive nasal swab for SARS-CoV-2 (28 February–31 July 2020; n=35 879). We assess...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002252.full |
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| author | Edward J Boyko Pandora L Wander Elliott Lowy Lauren A Beste Luis Tulloch-Palomino Anna Korpak Alexander C Peterson Bessie A Young |
| author_facet | Edward J Boyko Pandora L Wander Elliott Lowy Lauren A Beste Luis Tulloch-Palomino Anna Korpak Alexander C Peterson Bessie A Young |
| author_sort | Edward J Boyko |
| collection | DOAJ |
| description | Introduction Risk factors and mediators of associations of diabetes with COVID-19 outcomes are unclear.Research design and methods We identified all veterans receiving Department of Veterans Affairs healthcare with ≥1 positive nasal swab for SARS-CoV-2 (28 February–31 July 2020; n=35 879). We assessed associations of diabetes (with and without insulin use) with hospitalization, intensive care unit (ICU) admission, or death at 30 days, and with hazard of death until the censoring date. Among participants with diabetes (n=13 863), we examined associations of hemoglobin A1c and antihyperglycemic medication use with COVID-19 outcomes. We estimated mediation between diabetes and outcomes by comorbidities (cardiovascular disease, heart failure, and chronic kidney disease), statin or ACE inhibitor/angiotensin receptor blocker (ARB) use, and cardiac biomarkers (brain natriuretic peptide and troponin).Results Diabetes with and without insulin use was associated with greater odds of hospitalization, ICU admission, and death at 30 days, and with greater hazard of death compared with no diabetes (OR 1.73, 1.76 and 1.63, and HR 1.61; and OR 1.39, 1.49 and 1.33, and HR 1.37, respectively, all p<0.0001). Prior sulfonylurea use was associated with greater odds of hospitalization and prior insulin use with hospitalization and death among patients with diabetes; among all participants, statin use was associated with lower mortality and ARB use with lower odds of hospitalization. Cardiovascular disease-related factors mediated <20% of associations between diabetes and outcomes.Conclusions Diabetes is independently associated with adverse outcomes from COVID-19. Associations are only partially mediated by common comorbidities. |
| format | Article |
| id | doaj-art-bc4ba2cf862b4430a7a9c91e478e5688 |
| institution | OA Journals |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-bc4ba2cf862b4430a7a9c91e478e56882025-08-20T01:59:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2021-002252Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19Edward J Boyko0Pandora L Wander1Elliott Lowy2Lauren A Beste3Luis Tulloch-Palomino4Anna Korpak5Alexander C Peterson6Bessie A Young7Department of Medicine, University of Washington, Seattle, Washington, USAVeterans Affairs Puget Sound Health Care System Seattle Division, Seattle, Washington, USAVeterans Affairs Puget Sound Health Care System Seattle Division, Seattle, Washington, USAVeterans Affairs Puget Sound Health Care System Seattle Division, Seattle, Washington, USAVeterans Affairs Puget Sound Health Care System Seattle Division, Seattle, Washington, USASeattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USAVeterans Affairs Puget Sound Health Care System Seattle Division, Seattle, Washington, USAVeterans Affairs Puget Sound Health Care System, Seattle, Washington, USAIntroduction Risk factors and mediators of associations of diabetes with COVID-19 outcomes are unclear.Research design and methods We identified all veterans receiving Department of Veterans Affairs healthcare with ≥1 positive nasal swab for SARS-CoV-2 (28 February–31 July 2020; n=35 879). We assessed associations of diabetes (with and without insulin use) with hospitalization, intensive care unit (ICU) admission, or death at 30 days, and with hazard of death until the censoring date. Among participants with diabetes (n=13 863), we examined associations of hemoglobin A1c and antihyperglycemic medication use with COVID-19 outcomes. We estimated mediation between diabetes and outcomes by comorbidities (cardiovascular disease, heart failure, and chronic kidney disease), statin or ACE inhibitor/angiotensin receptor blocker (ARB) use, and cardiac biomarkers (brain natriuretic peptide and troponin).Results Diabetes with and without insulin use was associated with greater odds of hospitalization, ICU admission, and death at 30 days, and with greater hazard of death compared with no diabetes (OR 1.73, 1.76 and 1.63, and HR 1.61; and OR 1.39, 1.49 and 1.33, and HR 1.37, respectively, all p<0.0001). Prior sulfonylurea use was associated with greater odds of hospitalization and prior insulin use with hospitalization and death among patients with diabetes; among all participants, statin use was associated with lower mortality and ARB use with lower odds of hospitalization. Cardiovascular disease-related factors mediated <20% of associations between diabetes and outcomes.Conclusions Diabetes is independently associated with adverse outcomes from COVID-19. Associations are only partially mediated by common comorbidities.https://drc.bmj.com/content/9/1/e002252.full |
| spellingShingle | Edward J Boyko Pandora L Wander Elliott Lowy Lauren A Beste Luis Tulloch-Palomino Anna Korpak Alexander C Peterson Bessie A Young Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19 BMJ Open Diabetes Research & Care |
| title | Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19 |
| title_full | Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19 |
| title_fullStr | Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19 |
| title_full_unstemmed | Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19 |
| title_short | Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19 |
| title_sort | risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with covid 19 |
| url | https://drc.bmj.com/content/9/1/e002252.full |
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