Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with Type 2 Diabetes Mellitus in the United States

Abstract

Introduction: Diabetes has been identified as a high-risk comorbidity for COVID-19 hospitalization. We evaluated additional risk factors for COVID-19 hospitalization and in-hospital mortality in a nationwide US database. Methods: This retrospective study utilized the UnitedHealth Group Clinical Discovery Database (January 1, 2019-July 15, 2020) containing de-identified nationwide administrative claims, SARS-CoV-2 laboratory test results, and COVID-19 inpatient admissions data. Logistic regression was used to understand risk factors for hospitalization and in-hospital mortality among people with type 2 diabetes (T2D) and in the overall population. Robustness of associations was further confirmed by subgroup and sensitivity analyses in the T2D population.Results: A total of 36,364 people were identified who were either SARS-CoV-2 ? or hospitalized for COVID-19. T2D was associated with increased COVID-19-related hospitalization and mortality. Factors associated with increased hospitalization risk were largely consistent in the overall population and the T2D subgroup, including age, male sex, and these top five comorbidities: dementia, metastatic tumor, congestive heart failure, paraplegia, and metabolic disease. Biguanides (mainly metformin) were consistently associated with lower odds of hospitalization, whereas sulfonylureas and insulins were associated with greater odds of hospitalization among people with T2D. Conclusion: In this nationwide US analysis, T2D was identified as an independent risk factor for COVID-19 complications. Many factors conferred similar risk of hospitalization across both populations; however, particular diabetes medications may be markers for differential risk. The insights on comorbidities and medications may inform population health initiatives, including prevention efforts for high-risk patient populations such as those with T2D.

Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland

“…Patients with type 2 diabetes using insulin had significantly higher odds of adverse events, which was expected, as insulin use is an indicator of an advanced stage of diabetes. This finding was consistent with other large studies 23–25. For instance, among 64 892 veterans with diabetes and COVID-19, insulin use was associated with higher odds of hospitalization and risk of death 25.…”

Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis

“…However, notably, iatrogenic hyperinsulinemia caused by exogenous insulin use might lead to adverse effects, including insulin resistance due to downregulation of insulin receptors, vascular changes, and subsequent adverse cardiovascular outcomes [96]. Moreover, our subgroup analyses as well as those from previous publications controlling for severity markers did not eliminate the association, raising concerns about the actual harmful effects of insulin [17]. Like DPP-4i, the increased risk of death among insulin users should be cautiously interpreted.…”

Metformin in SARS-CoV-2 infection: A hidden path – from altered inflammation to reduced mortality. A review from the literature

“…Nonetheless, no data about metabolic control differences was given, and the authors only admitted that metformin use may reflect less advanced diabetes and fewer complications. Boye et al 48 analyzed 36,364 insured patients admitted for COVID-19 and concluded that metformin was associated with lower odds of hospitalization (OR 0.78; 95 % CI 0.71–0.86). In another study of ensured patients, Ghany et al 39 verified that metformin use was linked to a lower hospital admission (HR 0.71; 95 % CI 0.52–0.86; p = 0.01), but found no significant effect on the duration of hospitalization (median length of stay for metformin users was 11 days [IQR 5–46] and 14 days [IQR 6–30] for non-users; p = 0.5).…”