American Diabetes Association
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Glycemic Control and Clinical Outcomes in U.S. Patients With COVID-19: Data From the National COVID Cohort Collaborative (N3C) Database

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posted on 2022-02-24, 18:29 authored by Rachel Wong, Margaret Hall, Rohith Vaddavalli, Adit Anand, Neha Arora, Carolyn T. Bramante, Victor Garcia, Steven Johnson, Mary Saltz, Jena S. Tronieri, Yun Jae Yoo, John B. Buse, Joel Saltz, Joshua Miller, Richard Moffitt
Objective: The purpose of the study is to evaluate the relationship between HbA1c and severity of COVID-19 outcomes in patients with type 2 diabetes mellitus (T2D) with acute COVID-19 infection.

Research Design and Methods: We conducted a retrospective study using observational data from the National COVID Cohort Collaborative (N3C), a longitudinal, multicenter US cohort of patients with COVID-19 infection. Patients were ≥18 years old with T2D and confirmed COVID-19 infection by either laboratory testing or diagnosis code. The primary outcome was 30-day mortality following the date of COVID-19 diagnosis. Secondary outcomes included need for invasive ventilation or ECMO, hospitalization within 7 days prior to or 30 days after COVID-19 diagnosis, and length of stay (LOS) for patients who were hospitalized.

Results: The study included 39,616 patients (50.9% female, 55.4% White, 26.4% Black or African American and 16.1% Hispanic or Latino, with mean [SD] age 62.1 [13.9] years and mean [SD] HbA1c 7.6% [2.0]. There was an increasing risk of hospitalization with incrementally higher HbA1c levels, but risk of death plateaued at HbA1c above 8% and risk of invasive ventilation or ECMO plateaued above 9%. There was no significant difference in LOS across HbA1c levels.

Conclusions: In a large, multicenter cohort of patients in the US with T2D and COVID-19 infection, risk of hospitalization increased with incrementally higher HbA1c levels. Risk of death and invasive ventilation also increased but plateaued at different levels of glycemic control.


Sources of Funding: This work was supported by NCATS U24 TR002306, UL1TR002489, CTB was supported by DK12654-01A1. N3C Attribution The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave ( and supported by NCATS U24 TR002306. Additional support was received from the National Institute of General Medical Sciences 5U54GM104942-04. This research was possible because of the patients whose information is included within the data from participating organizations ( and the organizations and scientists ( who have contributed to the on-going development of this community resource (cite this: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Authorship was determined using ICMJE recommendations. Data Partners with Released Data Stony Brook University — U24TR002306 • University of Oklahoma Health Sciences Center — U54GM104938: Oklahoma Clinical and Translational Science Institute (OCTSI) • West Virginia University — U54GM104942: West Virginia Clinical and Translational Science Institute (WVCTSI) • University of Mississippi Medical Center — U54GM115428: Mississippi Center for Clinical and Translational Research (CCTR) • University of Nebraska Medical Center — U54GM115458: Great Plains IDeA-Clinical & Translational Research • Maine Medical Center — U54GM115516: Northern New England Clinical & Translational Research (NNE-CTR) Network • Wake Forest University Health Sciences — UL1TR001420: Wake Forest Clinical and Translational Science Institute • Northwestern University at Chicago — UL1TR001422: Northwestern University Clinical and Translational Science Institute (NUCATS) • University of Cincinnati — UL1TR001425: Center for Clinical and Translational Science and Training • The University of Texas Medical Br


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