Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
Department of Medicine, University of Washington, Seattle, Washington, USA.
BMJ Open Diabetes Res Care. 2021 Jun;9(1). doi: 10.1136/bmjdrc-2021-002252.
Risk factors and mediators of associations of diabetes with COVID-19 outcomes are unclear.
We identified all veterans receiving Department of Veterans Affairs healthcare with ≥1 positive nasal swab for SARS-CoV-2 (28 February-31 July 2020; n=35 879). We assessed associations of diabetes (with and without insulin use) with hospitalization, intensive care unit (ICU) admission, or death at 30 days, and with hazard of death until the censoring date. Among participants with diabetes (n=13 863), we examined associations of hemoglobin A1c and antihyperglycemic medication use with COVID-19 outcomes. We estimated mediation between diabetes and outcomes by comorbidities (cardiovascular disease, heart failure, and chronic kidney disease), statin or ACE inhibitor/angiotensin receptor blocker (ARB) use, and cardiac biomarkers (brain natriuretic peptide and troponin).
Diabetes with and without insulin use was associated with greater odds of hospitalization, ICU admission, and death at 30 days, and with greater hazard of death compared with no diabetes (OR 1.73, 1.76 and 1.63, and HR 1.61; and OR 1.39, 1.49 and 1.33, and HR 1.37, respectively, all p<0.0001). Prior sulfonylurea use was associated with greater odds of hospitalization and prior insulin use with hospitalization and death among patients with diabetes; among all participants, statin use was associated with lower mortality and ARB use with lower odds of hospitalization. Cardiovascular disease-related factors mediated <20% of associations between diabetes and outcomes.
Diabetes is independently associated with adverse outcomes from COVID-19. Associations are only partially mediated by common comorbidities.
糖尿病与 COVID-19 结局相关的风险因素和中介因素尚不清楚。
我们确定了所有在 2020 年 2 月 28 日至 7 月 31 日期间接受退伍军人事务部医疗保健服务且至少有 1 次 SARS-CoV-2 鼻拭子检测阳性的退伍军人（n=35879）。我们评估了糖尿病（有无胰岛素使用）与 30 天内住院、入住重症监护病房（ICU）或死亡以及直至截止日期的死亡风险之间的关联。在患有糖尿病的参与者（n=13863）中，我们检查了糖化血红蛋白和抗高血糖药物使用与 COVID-19 结局之间的关联。我们通过合并症（心血管疾病、心力衰竭和慢性肾脏病）、他汀类药物或 ACE 抑制剂/血管紧张素受体阻滞剂（ARB）使用以及心脏生物标志物（脑钠肽和肌钙蛋白）来估计糖尿病与结局之间的中介作用。
与无糖尿病相比，有或无胰岛素使用的糖尿病与住院、入住 ICU 和 30 天内死亡的几率更高，与死亡的风险比更高（OR 1.73、1.76 和 1.63，以及 HR 1.61；OR 1.39、1.49 和 1.33，以及 HR 1.37，均 P<0.0001）。磺酰脲类药物的既往使用与糖尿病患者的住院几率增加有关，而胰岛素的既往使用与住院和死亡有关；在所有参与者中，他汀类药物的使用与死亡率降低有关，而 ARB 的使用与住院几率降低有关。心血管疾病相关因素仅部分中介了糖尿病与结局之间的关联。
糖尿病与 COVID-19 的不良结局独立相关。关联仅部分由常见合并症中介。
