Objective: CVD is the leading cause of death and disability among individuals with T2D. National guidelines recommend an SGLT2i or GLP-1 RA in patients with T2D who have or are at high risk for CVD. ...This study examined the impact of SGLT2i or GLP-1 RA on clinical outcomes in patients with pre-existing T2D+CVD who developed COVID-19.
Methods: Adult patients with T2D+CVD who developed COVID-19 during 03/01/20-05/31/22 and had ≥1 year of health plan enrollment before the COVID-19 diagnosis were identified from the Healthcare Integrated Research Database (HIRD®). Eligible patients were classified as guideline concordant or not based on SGLT2i or GLP-1 RA prescription fills in the year before COVID-19 infection. COVID-19 related and all-cause hospitalization, ICU admission, and mortality were compared between SGLT2i or GLP-1 RA users and non-users. Propensity score (PS) matching and multivariable analyses were performed.
Results: A total of 42,646 COVID-19 patients with T2D+CVD were identified with a mean follow-up of 8.6 months. The use of SGLT2i or GLP-1 RA was low (n=8,498; 20%). Patients receiving SGLT2i or GLP-1 RA were younger, had fewer comorbidities, took more CVD prevention medications, and were less likely to be hospitalized during the year before COVID-19 infection than non-users. After PS matching and multivariable adjustment, T2D+CVD patients with COVID-19 who received SGLT2i or GLP-1 RA were 12% less likely to be hospitalized and 10% less likely to be admitted to the ICU due to COVID-19 compared to those who did not (n=8,479 each group; both p<0.05). Reductions were also observed for all-cause hospitalization (6%), ICU admission (7%), and mortality (10%), but the results were not statistically significant.
Conclusion: The findings suggest that SGLT2i and GLP-1 RA may improve outcomes in T2D+CVD patients with COVID-19 and support existing national guidelines.
Disclosure
C. Nguyen: Employee; HealthCore Inc. C. L. Crowe: Employee; HealthCore Inc. E. Kuti: Employee; Boehringer Ingelheim Inc. B. M. K. Donato: Employee; Boehringer Ingelheim Pharmaceuticals Inc. R. L. Djaraher: None. L. J. Seman: Employee; Boehringer Ingelheim Pharmaceuticals Inc. N. Graeter: None. T. P. Power: None. V. Willey: Other Relationship; Novo Nordisk A/S.
Funding
Boehringer Ingelheim
Aim
To compare adverse outcomes among COVID‐19 patients with pre‐existing type 2 diabetes (T2D) only, T2D and cardiovascular disease (CVD), or neither.
Methods
This retrospective cohort study used ...administrative claims, laboratory and mortality data from the HealthCore Integrated Research Database. Patients with COVID‐19 were identified from 3 January 2020 to 31 May 2021 and stratified by the presence of T2D and CVD. Outcomes included hospitalization, intensive care unit (ICU) admission, mortality and complications following COVID‐19 infection. Propensity score matching and multivariable analyses were performed.
Results
A total of 321 232 COVID‐19 patients were identified (21 651 T2D + CVD, 28 184 T2D only, and 271 397 neither) with a mean (SD) follow‐up of 5.4 (3.0) months. After matching, 6 967 patients were identified for each group, and residual baseline differences remained. Adjusted analyses showed that COVID‐19 patients with T2D + CVD were 59% more probable to be hospitalized, 74% more probable to be admitted to the ICU, and had a 26% higher mortality risk than those with neither. COVID‐19 patients with T2D only were 28% and 32% more probable to be admitted to the hospital and ICU than those with neither, respectively. Among all T2D + CVD patients, acute respiratory distress syndrome (31%) and acute kidney disease (24%) were observed.
Conclusion
Our study highlights the incrementally poorer outcomes associated with pre‐existing T2D + CVD in COVID‐19 patients compared with those without T2D/CVD and suggests consideration of a more optimal management approach in these patients.
The economic burden associated with type 2 diabetes mellitus (T2DM) and concurrent cardiovascular disease (CVD) among patients with COVID-19 is unclear.
We compared healthcare resource utilization ...(HCRU) and costs in patients with COVID-19 and T2DM and CVD (T2DM + CVD), T2DM only, or neither T2DM nor CVD (T2DM/CVD).
A retrospective observational study in COVID-19 patients using data from the Healthcare Integrated Research Database (HIRD®) was conducted. Patients with COVID-19 were identified between March 1, 2020, and May 31, 2021, and followed from first diagnosis or positive lab test to the end of health plan enrollment, end of study period, or death. Patients were assigned one of 3 cohorts: pre-existing T2DM+CVD, T2DM only, or neither T2DM/CVD. Propensity score matching and multivariable analyses were performed to control for differences in baseline characteristics. Study outcomes included all-cause and COVID-19-related HCRU and costs.
In all, 321 232 COVID-19 patients were identified (21 651 with T2DM + CVD, 28 184 with T2DM only, and 271 397 with neither T2DM/CVD). After matching, 6967 patients were in each group. Before matching, 46.0% of patients in the T2DM + CVD cohort were hospitalized for any cause, compared with 18.0% in the T2DM-only cohort and 6.3% in the neither T2DM/CVD cohort; the corresponding values after matching were 34.2%, 26.0%, and 21.2%. The proportion of patients with emergency department visits, telehealth visits, or use of skilled nursing facilities was higher in patients with COVID-19 and T2DM + CVD compared with the other cohorts. Average all-cause costs during follow-up were
7882, and $7277 per-patient-per-month after matching for patients with T2DM + CVD, T2DM-only, and neither T2DM/CVD, respectively. COVID-19-related costs contributed to 78%, 75%, and 64% of the overall costs, respectively. The multivariable model showed that per-patient-per-month all-cause costs for T2DM + CVD and T2DM-only were 54% and 21% higher, respectively, than those with neither T2DM/CVD after adjusting for residual confounding.
HCRU and costs in patients were incrementally higher with COVID-19 and pre-existing T2DM + CVD compared with those with T2DM-only and neither T2DM/CVD, even after accounting for baseline differences between groups, confirming that pre-existing T2DM + CVD is associated with increased HCRU and costs in COVID-19 patients, highlighting the importance of proactive management.
Objective: The association of T2D and severe C-19 outcomes has been reported, but data are scarce on whether pre-existing CVD impacts C-19 outcomes in T2D patients. This study compared the clinical ...outcomes among C-19 patients with pre-existing T2D, T2D+CVD, or neither.
Methods: Retrospective study of claims and lab data to identify C-19 patients from 3/1/20 - 5/31/21 and stratify them by the presence of T2D and CVD. Outcomes included hospital/ICU admission and mortality. Propensity score matching and multivariable analyses were performed.
Results: After matching, 6,967 patients were identified for each group with a mean follow-up of 5.4 months; minimal residual baseline differences remained. Adjusted analyses (Table) show that C-19 patients with T2D+CVD or T2D only were more likely to be admitted to the hospital/ICU than those with neither (all p <0.01) , with the T2D+CVD group having greater odds. C-19 patients with T2D+CVD had a higher mortality risk compared to those with neither (p=0.02) . Among all T2D+CVD patients, acute respiratory distress syndrome (31%) , acute kidney disease (24%) , and ventilator use (8%) were observed.
Conclusion: Our study highlights the incrementally poorer outcomes associated with pre-existing T2D+CVD in C-19 patients and may suggest consideration of a more aggressive management approach in these patients with a less favorable prognosis.
Disclosure
C. Nguyen: Employee; HealthCore Inc. T. P. Power: None. R. Mehra: None. V. Willey: Employee; HealthCore Inc. C. Crowe: None. E. Kuti: Employee; Boehringer Ingelheim International GmbH. N. Narsipur: Employee; Boehringer Ingelheim International GmbH, Janssen Scientific Affairs, LLC. B. M. K. Donato: Employee; Boehringer Ingelheim International GmbH. R. S. Pepe: None. R. L. Djaraher: None. L. J. Seman: n/a. N. Graeter: Employee; Boehringer Ingelheim International GmbH.
Funding
Boehringer Ingelheim Pharmaceuticals Inc.
