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 usingCerner Real-World Data™

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.