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Table 2

Associations of HbA1c and glucose-lowering medication use with adverse outcomes from COVID-19 among veterans with diabetes

Hospital admission within 30 days of diagnosis (n = 64,892)ICU admission within 30 days of diagnosis (n = 64,865)Death within 30 days of diagnosis (n = 64,892)Death by 31 December 2020 (n = 64,786)
OR95% CIOR95% CIOR95% CIHR95% CI
HbA1c, %         
 <7.0 Ref  Ref  Ref  Ref  
 7.0–7.9 0.99 0.93–1.04 1.00 0.92–1.09 1.07 0.99–1.16 1.04 0.98–1.11 
 8.0–8.9 1.03 0.96–1.10 1.05 0.94–1.17 1.07 0.97–1.19 1.05 0.97–1.14 
 ≥9.0 1.27 1.19–1.35 1.28 1.15–1.42 1.30 1.17–1.44 1.22 1.12–1.32 
Metformin 0.96 0.92–1.01 0.98 0.91–1.06 0.84 0.78–0.91 0.84 0.79–0.89 
Sulfonylurea 1.02 0.96–1.08 1.04 0.95–1.14 1.00 0.92–1.10 0.99 0.93–1.07 
Thiazolidinedione 1.04 0.93–1.17 0.97 0.80–1.19 1.07 0.88–1.30 1.06 0.90–1.24 
DPP4i 1.00 0.93–1.07 1.00 0.89–1.13 0.99 0.89–1.12 1.03 0.94–1.13 
GLP1-RA 0.88 0.81–0.96 0.87 0.76–1.00 0.98 0.86–1.12 0.93 0.84–1.04 
SGLT2i 0.92 0.85–0.99 0.93 0.82–1.06 0.82 0.72–0.94 0.82 0.74–0.92 
Insulin 1.12 1.07–1.18 1.12 1.04–1.22 1.18 1.09–1.27 1.20 1.13–1.27 
Female sex at birth 0.94 0.85–1.04 0.88 0.75–1.04 0.65 0.52–0.80 0.65 0.55–0.78 
Age category, years         
 19–39 0.81 0.67–0.98 0.72 0.50–1.05 0.39 0.19–0.80 0.26 0.13–0.52 
 40–49 0.79 0.70–0.90 0.66 0.52–0.83 0.51 0.34–0.76 0.45 0.32–0.63 
 50–59 Ref  Ref  Ref  Ref  
 60–69 1.23 1.14–1.32 1.23 1.09–1.38 2.30 1.94–2.72 2.14 1.87–2.46 
 70–79 1.34 1.25–1.44 1.48 1.31–1.66 4.36 3.70–5.15 3.74 3.28–4.27 
 ≥80 1.74 1.59–1.90 1.78 1.55–2.05 8.97 7.51–10.70 7.05 6.13–8.10 
White (vs. not White) 0.94 0.87–1.01 0.8 0.76–0.96 0.82 0.74–0.92 0.89 0.81–0.97 
Black (vs. not Black) 1.40 1.29–1.52 1.21 1.06–1.37 0.80 0.71–0.91 0.84 0.76–0.93 
Hispanic (vs. not Hispanic) 1.17 1.08–1.26 1.25 1.11–1.41 1.21 1.08–1.36 1.12 1.02–1.23 
BMI category, kg/m2         
 <18.5 0.91 0.71–1.16 1.14 0.80–1.61 1.37 0.99–1.89 1.36 1.10–1.69 
 18.5–24.9 Ref  Ref  Ref  Ref  
 25–29.9 0.86 0.80–0.93 0.95 0.84–1.07 0.88 0.79–0.98 0.83 0.76–0.90 
 30–34.9 0.81 0.76–0.88 0.98 0.87–1.10 0.87 0.78–0.98 0.77 0.71–0.84 
 35–39.9 0.82 0.76–0.89 1.01 0.89–1.15 0.82 0.72–0.93 0.76 0.68–0.84 
 ≥40 0.90 0.82–0.99 1.10 0.95–1.28 0.99 0.85–1.15 0.84 0.75–0.95 
Tobacco use         
 Never Ref  Ref  Ref  Ref  
 Former 1.17 1.11–1.23 1.23 1.12–1.34 1.27 1.17–1.38 1.21 1.13–1.29 
 Current 1.32 1.25–1.40 1.30 1.18–1.43 1.27 1.15–1.40 1.26 1.16–1.35 
ACEi 1.03 0.98–1.08 1.11 1.03–1.20 0.88 0.81–0.95 0.86 0.81–0.92 
ARB 0.94 0.89–0.99 1.00 0.92–1.10 0.83 0.76–0.91 0.82 0.76–0.88 
Statin 0.94 0.90–0.99 0.94 0.87–1.02 0.83 0.77–0.89 0.81 0.77–0.86 
Platelet inhibitor 1.08 1.03–1.13 1.04 0.97–1.12 1.12 1.05–1.21 1.11 1.05–1.18 
Hypertension 1.25 1.15–1.36 1.27 1.09–1.48 1.06 0.92–1.22 1.09 0.97–1.22 
Cardiovascular disease 1.56 1.48–1.64 1.53 1.40–1.66 1.31 1.20–1.41 1.38 1.29–1.47 
Heart failure 1.67 1.59–1.76 1.57 1.46–1.70 1.29 1.20–1.38 1.35 1.28–1.43 
eGFR, mL/min/1.73 m²         
 ≥90 Ref  Ref  Ref  Ref  
 60–89 0.97 0.91–1.03 1.00 0.90–1.12 1.15 1.02–1.29 1.04 0.95–1.144 
 45–59 1.07 0.99–1.15 1.12 0.99–1.26 1.43 1.26–1.62 1.25 1.14–1.38 
 30–44 1.20 1.10–1.30 1.27 1.11–1.45 1.70 1.48–1.94 1.52 1.38–1.69 
 15–29 1.42 1.27–1.58 1.69 1.44–1.99 2.43 2.07–2.86 2.00 1.77–2.25 
 <15 or dialysis 1.58 1.40–1.79 1.74 1.45–2.08 2.16 1.81–2.58 2.00 1.76–2.28 
 Urban/rural/highly rural residence         
 Highly rural 0.64 0.51–0.78 0.81 0.58–1.13 1.58 1.24–2.01 1.45 1.19–1.75 
 Rural 0.70 0.67–0.73 0.80 0.74–0.87 1.02 0.95–1.09 0.99 0.94–1.05 
 Urban Ref  Ref  Ref  Ref  
Hospital admission within 30 days of diagnosis (n = 64,892)ICU admission within 30 days of diagnosis (n = 64,865)Death within 30 days of diagnosis (n = 64,892)Death by 31 December 2020 (n = 64,786)
OR95% CIOR95% CIOR95% CIHR95% CI
HbA1c, %         
 <7.0 Ref  Ref  Ref  Ref  
 7.0–7.9 0.99 0.93–1.04 1.00 0.92–1.09 1.07 0.99–1.16 1.04 0.98–1.11 
 8.0–8.9 1.03 0.96–1.10 1.05 0.94–1.17 1.07 0.97–1.19 1.05 0.97–1.14 
 ≥9.0 1.27 1.19–1.35 1.28 1.15–1.42 1.30 1.17–1.44 1.22 1.12–1.32 
Metformin 0.96 0.92–1.01 0.98 0.91–1.06 0.84 0.78–0.91 0.84 0.79–0.89 
Sulfonylurea 1.02 0.96–1.08 1.04 0.95–1.14 1.00 0.92–1.10 0.99 0.93–1.07 
Thiazolidinedione 1.04 0.93–1.17 0.97 0.80–1.19 1.07 0.88–1.30 1.06 0.90–1.24 
DPP4i 1.00 0.93–1.07 1.00 0.89–1.13 0.99 0.89–1.12 1.03 0.94–1.13 
GLP1-RA 0.88 0.81–0.96 0.87 0.76–1.00 0.98 0.86–1.12 0.93 0.84–1.04 
SGLT2i 0.92 0.85–0.99 0.93 0.82–1.06 0.82 0.72–0.94 0.82 0.74–0.92 
Insulin 1.12 1.07–1.18 1.12 1.04–1.22 1.18 1.09–1.27 1.20 1.13–1.27 
Female sex at birth 0.94 0.85–1.04 0.88 0.75–1.04 0.65 0.52–0.80 0.65 0.55–0.78 
Age category, years         
 19–39 0.81 0.67–0.98 0.72 0.50–1.05 0.39 0.19–0.80 0.26 0.13–0.52 
 40–49 0.79 0.70–0.90 0.66 0.52–0.83 0.51 0.34–0.76 0.45 0.32–0.63 
 50–59 Ref  Ref  Ref  Ref  
 60–69 1.23 1.14–1.32 1.23 1.09–1.38 2.30 1.94–2.72 2.14 1.87–2.46 
 70–79 1.34 1.25–1.44 1.48 1.31–1.66 4.36 3.70–5.15 3.74 3.28–4.27 
 ≥80 1.74 1.59–1.90 1.78 1.55–2.05 8.97 7.51–10.70 7.05 6.13–8.10 
White (vs. not White) 0.94 0.87–1.01 0.8 0.76–0.96 0.82 0.74–0.92 0.89 0.81–0.97 
Black (vs. not Black) 1.40 1.29–1.52 1.21 1.06–1.37 0.80 0.71–0.91 0.84 0.76–0.93 
Hispanic (vs. not Hispanic) 1.17 1.08–1.26 1.25 1.11–1.41 1.21 1.08–1.36 1.12 1.02–1.23 
BMI category, kg/m2         
 <18.5 0.91 0.71–1.16 1.14 0.80–1.61 1.37 0.99–1.89 1.36 1.10–1.69 
 18.5–24.9 Ref  Ref  Ref  Ref  
 25–29.9 0.86 0.80–0.93 0.95 0.84–1.07 0.88 0.79–0.98 0.83 0.76–0.90 
 30–34.9 0.81 0.76–0.88 0.98 0.87–1.10 0.87 0.78–0.98 0.77 0.71–0.84 
 35–39.9 0.82 0.76–0.89 1.01 0.89–1.15 0.82 0.72–0.93 0.76 0.68–0.84 
 ≥40 0.90 0.82–0.99 1.10 0.95–1.28 0.99 0.85–1.15 0.84 0.75–0.95 
Tobacco use         
 Never Ref  Ref  Ref  Ref  
 Former 1.17 1.11–1.23 1.23 1.12–1.34 1.27 1.17–1.38 1.21 1.13–1.29 
 Current 1.32 1.25–1.40 1.30 1.18–1.43 1.27 1.15–1.40 1.26 1.16–1.35 
ACEi 1.03 0.98–1.08 1.11 1.03–1.20 0.88 0.81–0.95 0.86 0.81–0.92 
ARB 0.94 0.89–0.99 1.00 0.92–1.10 0.83 0.76–0.91 0.82 0.76–0.88 
Statin 0.94 0.90–0.99 0.94 0.87–1.02 0.83 0.77–0.89 0.81 0.77–0.86 
Platelet inhibitor 1.08 1.03–1.13 1.04 0.97–1.12 1.12 1.05–1.21 1.11 1.05–1.18 
Hypertension 1.25 1.15–1.36 1.27 1.09–1.48 1.06 0.92–1.22 1.09 0.97–1.22 
Cardiovascular disease 1.56 1.48–1.64 1.53 1.40–1.66 1.31 1.20–1.41 1.38 1.29–1.47 
Heart failure 1.67 1.59–1.76 1.57 1.46–1.70 1.29 1.20–1.38 1.35 1.28–1.43 
eGFR, mL/min/1.73 m²         
 ≥90 Ref  Ref  Ref  Ref  
 60–89 0.97 0.91–1.03 1.00 0.90–1.12 1.15 1.02–1.29 1.04 0.95–1.144 
 45–59 1.07 0.99–1.15 1.12 0.99–1.26 1.43 1.26–1.62 1.25 1.14–1.38 
 30–44 1.20 1.10–1.30 1.27 1.11–1.45 1.70 1.48–1.94 1.52 1.38–1.69 
 15–29 1.42 1.27–1.58 1.69 1.44–1.99 2.43 2.07–2.86 2.00 1.77–2.25 
 <15 or dialysis 1.58 1.40–1.79 1.74 1.45–2.08 2.16 1.81–2.58 2.00 1.76–2.28 
 Urban/rural/highly rural residence         
 Highly rural 0.64 0.51–0.78 0.81 0.58–1.13 1.58 1.24–2.01 1.45 1.19–1.75 
 Rural 0.70 0.67–0.73 0.80 0.74–0.87 1.02 0.95–1.09 0.99 0.94–1.05 
 Urban Ref  Ref  Ref  Ref  

Cox models did not include individuals who died on the index date. Models additionally adjusted for geographic location by Veterans Integrated Service Network location and by month of COVID-19 diagnosis. Ref, reference.

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