Gupta Juhi K, Ravindrarajah Rathi, Tilston George, Ollier William, Ashcroft Darren M, Heald Adrian H
Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
Diabetes Ther. 2025 Feb;16(2):241-256. doi: 10.1007/s13300-024-01681-9. Epub 2024 Dec 20.
It is widely accepted that the higher the number of medications prescribed and taken by an individual, the higher the risk of poor health outcomes. We have investigated whether polypharmacy and comorbidities conveyed more risk of adverse health outcomes following COVID-19 infection (as a paradigm of serious viral infections in general) in people with type 1 diabetes (T1DM) or type 2 diabetes (T2DM).
The Greater Manchester Care Record (GMCR) is an integrated database of electronic health records containing data collected from 433 general practices in Greater Manchester. Baseline demographic information (age, body mass index [BMI], gender, ethnicity, smoking status, deprivation index), hospital admission or death within 28 days of infection were extracted for adults (18+) diagnosed with either T1DM or T2DM.
The study cohort included individuals diagnosed as T1DM and T2DM separately. Across the Greater Manchester Region, a total of 145,907 individuals were diagnosed with T2DM and 9705 were diagnosed with T1DM. For the T2DM individuals, 45.2% were women and for the T1DM individuals, 42.7% were women. For T2DM, 16-20 medications (p = 0.005; odds ratio [OR] [95% confidence interval (CI) 2.375 [1.306-4.319]) and > 20 medications (p < 0.001; OR [95% CI] 3.141 [1.755-5.621]) were associated with increased risk of death following COVID-19 infection. Increased risk of hospital admissions in T2DM individuals was associated with 11 to 15 medications (p = 0.013; OR = 1.341 (95% CI) [1.063-1.692]). This was independent of comorbidities, metabolic and demographic factors. For T1DM, there was no association of polypharmacy with hospital admission. Additionally, respiratory, cardiovascular/cerebrovascular and gastrointestinal conditions were associated with increased risk of hospital admissions and deaths in T2DM (p < 0.001). Many comorbidities were common across both T1DM and T2DM.
We have shown in T2DM an independent association of multiple medications taken from 11 upwards with adverse health consequences following COVID-19 infection. We also found that individuals with diabetes develop comorbidities that were common across both T1DM and T2DM. This study has laid the foundation for future investigations into the way that complex pharmacological interactions may influence clinical outcomes in people with T2DM.
人们普遍认为，个人所开具和服用的药物数量越多，健康状况不佳的风险就越高。我们调查了在1型糖尿病（T1DM）或2型糖尿病（T2DM）患者中，多重用药和合并症是否会在感染2019冠状病毒病（作为一般严重病毒感染的范例）后带来更多不良健康后果的风险。
大曼彻斯特护理记录（GMCR）是一个电子健康记录的综合数据库，包含从大曼彻斯特433家全科诊所收集的数据。提取了确诊为T1DM或T2DM的成年人（18岁及以上）的基线人口统计学信息（年龄、体重指数[BMI]、性别、种族、吸烟状况、贫困指数）以及感染后28天内的住院或死亡情况。
研究队列分别包括被诊断为T1DM和T2DM的个体。在大曼彻斯特地区，共有145,907人被诊断为T2DM，9705人被诊断为T1DM。对于T2DM个体，45.2%为女性；对于T1DM个体，42.7%为女性。对于T2DM，16 - 20种药物（p = 0.005；优势比[OR][95%置信区间（CI）]2.375[1.306 - 4.319]）和超过20种药物（p < 0.001；OR[95% CI]3.141[1.755 - 5.621]）与2019冠状病毒病感染后死亡风险增加相关。T2DM个体住院风险增加与11至15种药物相关（p = 0.013；OR = 1.341（95% CI）[1.063 - 1.692]）。这与合并症、代谢和人口统计学因素无关。对于T1DM，多重用药与住院无关。此外，呼吸系统、心血管/脑血管和胃肠道疾病与T2DM患者住院和死亡风险增加相关（p < 0.001）。许多合并症在T1DM和T2DM中都很常见。
我们已经表明，在T2DM中，服用11种及以上多种药物与2019冠状病毒病感染后的不良健康后果存在独立关联。我们还发现，糖尿病患者会出现T1DM和T2DM中都常见的合并症。这项研究为未来调查复杂的药物相互作用可能影响T2DM患者临床结局的方式奠定了基础。
