Glycemic Control and Clinical Outcomes in U.S. Patients With COVID-19: Data From the National COVID Cohort Collaborative (N3C) Database
Rachel Wong, Margaret Hall, Rohith Vaddavalli, Adit Anand, Neha Arora, Carolyn T. Bramante, Víctor García, Steve Johnson, Mary Saltz, Jena Shaw Tronieri, Yun Jae Yoo, John B. Buse, Joel Saltz, Joshua D. Miller, Richard A. Moffitt, Tellen D. Bennett, Elena Casiraghi, Christopher G. Chute, Peter E. DeWitt, Michael D. Evans, Kenneth Gersing, Andrew T. Girvin, Melissa Haendel, Jeremy Harper, Janos Hajagos, Stephanie Hong, Jared D. Huling, Emily Pfaff, Jane E.B. Reusch, Til Stürmer, Kenneth J. Wilkins, Jacob T. Wooldridge
Abstract
OBJECTIVE: The purpose of the study is to evaluate the relationship between HbA1c and severity of coronavirus disease 2019 (COVID-19) outcomes in patients with type 2 diabetes (T2D) with acute COVID-19 infection. RESEARCH DESIGN AND METHODS: We conducted a retrospective study using observational data from the National COVID Cohort Collaborative (N3C), a longitudinal, multicenter U.S. cohort of patients with COVID-19 infection. Patients were ≥18 years old with T2D and confirmed COVID-19 infection by laboratory testing or diagnosis code. The primary outcome was 30-day mortality following the date of COVID-19 diagnosis. Secondary outcomes included need for invasive ventilation or extracorporeal membrane oxygenation (ECMO), hospitalization within 7 days before or 30 days after COVID-19 diagnosis, and length of stay (LOS) for patients who were hospitalized. RESULTS: The study included 39,616 patients (50.9% female, 55.4% White, 26.4% Black or African American, and 16.1% Hispanic or Latino, with mean ± SD age 62.1 ± 13.9 years and mean ± SD HbA1c 7.6% ± 2.0). There was an increasing risk of hospitalization with incrementally higher HbA1c levels, but risk of death plateaued at HbA1c >8%, and risk of invasive ventilation or ECMO plateaued >9%. There was no significant difference in LOS across HbA1c levels. CONCLUSIONS: In a large, multicenter cohort of patients in the U.S. with T2D and COVID-19 infection, risk of hospitalization increased with incrementally higher HbA1c levels. Risk of death and invasive ventilation also increased but plateaued at different levels of glycemic control.