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. 2023 Jul 9;13(7):e071475.
doi: 10.1136/bmjopen-2022-071475.

Diabetes status and other factors as correlates of risk for thrombotic and thromboembolic events during SARS-CoV-2 infection: A nationwide retrospective case-control study using Cerner Real-World Data™

Erin M Tallon  1   2 , Mary Pat Gallagher  3 , Vincent S Staggs  4   5 , Diana Ferro  2   6 , Deepa Badrinath Murthy  3 , Osagie Ebekozien  7   8 , Mikhail N Kosiborod  9   10 , Marcus Lind  11   12   13 , Camila Manrique-Acevedo  14 , Chi-Ren Shyu  15   16 , Mark A Clements  2   5
Affiliations

Diabetes status and other factors as correlates of risk for thrombotic and thromboembolic events during SARS-CoV-2 infection: A nationwide retrospective case-control study using Cerner Real-World Data™

Erin M Tallon et al. BMJ Open. .

Abstract

Objectives: We sought to examine in individuals with SARS-CoV-2 infection whether risk for thrombotic and thromboembolic events (TTE) is modified by presence of a diabetes diagnosis. Furthermore, we analysed whether differential risk for TTEs exists in type 1 diabetes mellitus (T1DM) versus type 2 diabetes mellitus (T2DM).

Design: Retrospective case-control study.

Setting: The December 2020 version of the Cerner Real-World Data COVID-19 database is a deidentified, nationwide database containing electronic medical record (EMR) data from 87 US-based health systems.

Participants: We analysed EMR data for 322 482 patients >17 years old with suspected or confirmed SARS-CoV-2 infection who received care between December 2019 and mid-September 2020. Of these, 2750 had T1DM; 57 811 had T2DM; and 261 921 did not have diabetes.

Outcome: TTE, defined as presence of a diagnosis code for myocardial infarction, thrombotic stroke, pulmonary embolism, deep vein thrombosis or other TTE.

Results: Odds of TTE were substantially higher in patients with T1DM (adjusted OR (AOR) 2.23 (1.93-2.59)) and T2DM (AOR 1.52 (1.46-1.58)) versus no diabetes. Among patients with diabetes, odds of TTE were lower in T2DM versus T1DM (AOR 0.84 (0.72-0.98)).

Conclusions: Risk of TTE during COVID-19 illness is substantially higher in patients with diabetes. Further, risk for TTEs is higher in those with T1DM versus T2DM. Confirmation of increased diabetes-associated clotting risk in future studies may warrant incorporation of diabetes status into SARS-CoV-2 infection treatment algorithms.

Keywords: COVID-19; DIABETES & ENDOCRINOLOGY; Health informatics; Stroke; Thromboembolism.

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Conflict of interest statement

Competing interests: MAC is the Chief Medical Officer at Glooko. He receives research support from Dexcom and Abbott Diabetes Care. MNK receives, or has received, research grant support from AstraZeneca and Boehringer Ingelheim, as well as other research support form AstraZeneca. He receives, or has received, research honoraria from AstraZeneca, Boehringer Ingelheim and Novo Nordisk. He serves, or has served, as a consultant and/or advisor for Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Esperion Therapeutics, Janssen, Lexicon, Merck (Diabetes and Cardiovascular), Novo Nordisk, Pharmacosmos, Sanofi and Vifor Pharma. He has received support for attending meetings and/or travel from AstraZeneca, Bayer, Boehringer Ingelheim and Novo Nordisk, and he participated on an advisory board for Applied Therapeutics.

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