Diabetes Severity and the Risks of COVID-19 Infection and Severe COVID-19 Outcomes

Friday, August 26, 2022

6:25 PM – 6:30 PM CEST

Location: C1M2

Publication Number: 109

Background: Two years into the pandemic, little is known about whether diabetes mellitus (DM) increases the risk of COVID-19 infection and whether DM severity is related to risk of severe COVID-19 outcomes.

Objectives: To investigate the association of DM and DM severity with risk of COVID-19 infection and severe outcomes in 3 US integrated healthcare systems.

Methods: This retrospective cohort study included adults enrolled in Kaiser Permanente Colorado, Northwest, or Washington for ≥ 6 months as of February 29, 2020. We identified DM using diagnosis codes, laboratory results, and pharmacy fills for antidiabetic medications. DM severity measures included DM type (1 or 2), glycemic control (based on hemoglobin A1c [HbA1c] values), treatment intensity, and presence of DM complications. COVID-19 infection was defined as having a positive molecular test, hospitalization with a COVID-19 diagnosis, or death with COVID-19 listed as a cause. The severe COVID-19 outcome was a composite of invasive mechanical ventilation and COVID-19-associated death. We used repeated measures logistic regression models to estimate associations between time-varying measures of DM severity and odds of COVID-19 outcomes during each month from March 2020 through February 2021, adjusted for demographic variables, body mass index, comorbidities, and calendar time. Separate models were estimated for each DM severity construct, with adjusted odds ratios (aORs) presented relative to people without DM.

Results: Analyses included 141,095 people with DM and 766,168 without DM. COVID-19 infection occurred in 4.7% of people with type 1 DM, 4.2% with type 2 DM, and 3.3% without DM. The aOR for infection comparing type 1 DM with no DM was 1.41 (95% CI 1.27-1.57) and for type 2 DM, 1.27 (1.23-1.31). People using insulin had higher risk of infection than those with DM not using medications. Infection risk increased with worsening glycemic control: 3.9% of those with DM and HbA1c < 7% developed COVID-19 (aOR 1.21, 95% CI 1.15-1.26, vs. people without DM), as did 4.4% with HbA1c 7- < 9% (aOR 1.40, 95% CI 1.33-1.48), and 6.1% with HbA1c≥9% (aOR 1.62, 95% CI 1.51-1.75). Risk of severe COVID-19 outcomes was higher for people with type 1 DM (incidence 0.5%; aOR 2.87, 95% CI 1.99-4.15) and type 2 DM (0.3%; aOR 1.80, 95% CI 1.55-2.09) than people without DM (0.1%). The risk of severe COVID-19 was higher among people using insulin (aOR 2.65, 95% CI 2.13-3.28, vs. people without DM) than those with DM not using medications (aOR 1.68, 95% CI 1.41-2.01). Risk of severe outcomes increased with worse glycemic control, with incidence 0.4% among those with HbA1c≥9% (aOR 2.61, 95% CI 1.94-3.52).

Conclusions: In this population-based setting, DM and greater DM severity were associated with increased risks of COVID-19 infection and severe outcomes.

Presenting Author(s)

Sascha Dublin, MD, PhD

Senior Scientific Investigator
Kaiser Permanente Washington Health Research Institute
University of Washington, Seattle, Washington
Seattle, Washington, United States

Slides

Co-Author(s)

JF

James Floyd, MD, MS

Associate Professor
Department of Medicine, University of Washington
Seattle, WA, United States
RW

Rod Walker, MS

Biostatistician III
Kaiser Permanente Washington Health Research Institute
Seattle, WA, United States
JK

Jennifer Kuntz, PhD

Kaiser Permanente Center for Health Research
Portland, Oregon, United States
SS

Susan Shortreed, PhD

Senior Scientific Investigator
Kaiser Permanente Washington Health Research Institute
Seattle, WA, United States
SF

Stephen Fortmann, MD

Distinguished Investigator, Senior Director Science Programs
Kaiser Permanente Center for Health Research
Portland, OR, United States
EB

Elizabeth Bayliss, MD, MSPH

Senior Scientific Investigator
Institute for Health Research, Kaiser Permanente Colorado
Aurora, CO, United States
LH

Laura Harrington, PhD, MPH

Assistant Investigator
Kaiser Permanente Washington Health Research Institute
Seattle, WA, United States
SF

Sharon Fuller, BA

Programmer
Kaiser Permanente Washington Health Research Institute
Seattle, WA, United States
LA

Ladia Albertson-Junkans, MPH

Data Analytics and Reporting Consultant
Kaiser Permanente Washington Health Research Institute
Seattle, WA, United States
JP

John Powers, MS

Biostatistician
Institute for Health Research, Kaiser Permanente Colorado
Aurora, CO, United States
ML

Mi Lee, MPH

Data Report and Analytics Consultant III, Biostatistics
Kaiser Permanente Center for Health Research
Portland, OR, United States
LT

Lisa Temposky, BA

Research Project Manager
Kaiser Permanente Washington Health Research Institute
Seattle, WA, United States