Excess Mortality in COVID-19-Positive Versus COVID-19-Negative Inpatients With Diabetes: A Nationwide Study.

Diabetes is a major risk factor for death in those with coronavirus disease 2019 (COVID-19) infection (1). However, even those with diabetes who do not have a COVID-19 infection have an increased risk for mortality compared with those without diabetes (2). In the current study, we focused on hospitalized patients with diabetes and compared those who tested positive for COVID-19 infection to those who tested negative. Our aim was to identify the excess risk of mortality that COVID-19 infection adds among inpatients with diabetes and to assess if this increased mortality can be explained by underlying comorbidities/complications or if it is more closely related to the COVID-19 disease. For this cohort study, we used data from the Veterans Affairs (VA) Central Data Warehouse. We focused only on inpatients with diabetes who were evaluated for COVID-19 infection from 3 March 2020 to 21 May 2020 and for whom we were able to extract the available covariates. To avoid inaccurate diagnoses of diabetes, such as stress-induced hyperglycemia, we included only those who had diabetes prior to 1 January 2019. Diabetes was defined by ≥2 ICD-9/ICD-10 codes within 2 years prior to 1 January 2019 from inpatient or outpatient visits on separate days or prescription for diabetes medications within the current year (3). Prescriptions for metformin are sometimes provided to people with prediabetes and, therefore, may not always be a reliable indicator of diabetes diagnosis. Subjects were characterized as positive for COVID-19 …