Veterans with Diabetes and COVID-19: Research Highlights Adverse Outcomes and Medication Use Associations

Strategic Insights -

Researchers at Veterans Affairs Medical Center conducted a study to identify preinfection risk factors for adverse outcomes among veterans with diabetes and COVID-19 infection. The study analyzed data from 64,892 veterans with diabetes who contracted COVID-19 between March 1, 2020, and March 10, 2021. The research found that higher HbA(1c) and insulin use were directly associated with adverse outcomes, including hospitalization, intensive care unit admission, and mortality. In contrast, the use of certain glucose-lowering medications, such as glucagon-like peptide-1 receptor agonists (GLP1-RA), metformin, and sodium-glucose cotransporter 2 inhibitors (SGLT2i), was inversely associated with adverse outcomes.

Key Takeaways:

  • Higher HbA(1c) levels were directly associated with hospitalization, intensive care unit admission, and mortality among veterans with diabetes and COVID-19 (odds ratio [OR] 1.27 [95% CI 1.19-1.35], 1.28 [95% CI 1.15-1.42], and 1.30 [95% CI 1.17-1.44], respectively).
  • Insulin use was associated with higher odds of hospitalization, intensive care unit admission, and mortality among veterans with diabetes and COVID-19 (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], respectively).
  • The use of GLP1-RA, metformin, and SGLT2i was inversely associated with hospitalization among veterans with diabetes and COVID-19 (OR 0.92 [95% CI 0.85-0.99], 0.88 [95% CI 0.81-0.96], and 0.94 [95% CI 0.89-0.99], respectively).
  • The study found that the use of metformin and SGLT2i was associated with a lower risk of death among veterans with diabetes and COVID-19 (hazard ratio [HR] 0.84 [95% CI 0.79-0.89], 0.82 [95% CI 0.74-0.92], respectively).

Statistics:

  • 64,892 veterans with diabetes were analyzed in the study.
  • 30-day mortality rate was 9.0%.
  • Odds ratios for hospitalization, intensive care unit admission, and mortality among veterans with diabetes and COVID-19 were 1.27 (95% CI 1.19-1.35), 1.28 (95% CI 1.15-1.42), and 1.30 (95% CI 1.17-1.44), respectively.
  • Hazard ratios for death among veterans with diabetes and COVID-19 were 1.22 (95% CI 1.12-1.32) for HbA(1c) and 1.12 (95% CI 1.07-1.18) for insulin use.

Sources:

  • Prior Glucose-lowering Medication Use and 30-day Outcomes Among 64,892 Veterans With Diabetes and Covid-19. Diabetes Care, 2021;44(12):2708-2713.
  • Veterans Affairs Medical Center. Reports on Veterans Health from Veterans Affairs Medical Center Provide New Insights (Prior Glucose-lowering Medication Use and 30-day Outcomes Among 64,892 Veterans With Diabetes and Covid-19). Diabetes Week. March 28, 2022; p 607.