Prior Glucose-Lowering Medication Use and 30-Day Outcomes Among 64,892 Veterans With Diabetes and COVID-19

<b>Objective: </b>To identify pre-infection risk factors for adverse outcomes among Veterans with diabetes mellitus and COVID-19 infection. <p><b> </b></p> <p><b>Research design and methods: </b>We identified all Veterans Health Administration patients with diabetes and ≥1 positive nasal swab for SARS-CoV-2 (March 1, 2020–March 10, 2021) (n=64,892). We examined associations of HbA1c and glucose-lowering medication use with hospitalization, ICU admission, and mortality at 30 days using logistic regression models and over 4.4 months of follow-up (range <1–13.1 months) using proportional hazards models.</p> <p><b> </b></p> <p><b>Results: </b>Compared to HbA1c <7.0%, HbA1c ≥9.0% was associated with higher odds of hospitalization, ICU admission and death at 30 days as well as higher risk of death over 4.4 months (OR 1.27[95%CI 1.19–1.35], 1.28[95%CI 1.15–1.42], 1.30[95%CI 1.17–1.44]; HR 1.22[95%CI 1.12–1.32). Insulin use was associated with higher odds of hospitalization, ICU admission and death (OR 1.12[95%CI 1.07–1.18], 1.12[95%CI 1.04–1.22], and 1.18[95%CI 1.09–1.27]) and higher risk of death (HR 1.12[95%CI 1.07–1.18]). Sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor agonist (GLP1-RA), or angiotensin receptor blocker (ARB) use were associated with lower odds of hospitalization (OR 0.92[95%CI 0.85–0.99], OR 0.88[95%CI 0.81–0.96], and 0.94[95%CI 0.89–0.99]). Metformin and SGLT2i use were associated with lower odds and risk of death (OR 0.84[95%CI 0.78–0.91], 0.82[95%CI 0.72–0.94]; HR 0.84[95%CI 0.79–0.89], 0.82[95%CI 0.74–0.92).</p> <p> </p> <b>Conclusions: </b>Among Veterans with diabetes and COVID-19, higher HbA1c and insulin use were directly associated with adverse outcomes, while use of a GLP1-RA, metformin, and SGLT2i were inversely associated.