Association of polypharmacy and burden of comorbidities on COVID-19 adverse outcomes in people with type 1 or type 2 diabetes

Aim To investigate whether polypharmacy and comorbidities conveyed more risk of adverse health outcomes following COVID-19 infection in people with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). Materials and methods The Greater Manchester Care Record (GMCR) is an integrated database of electronic health records containing data collected from 433 general practices in Greater Manchester. Baseline demographic information (age, BMI, gender, ethnicity, smoking status, deprivation index), hospital admission or death within 28 days of infection were extracted for adults (18+) diagnosed with either T1DM or T2DM. Results For T2DM, 16 to 20 medications (p=0.01; OR [95% CI]=2.37 [1.31 to 4.32]) and > 20 medications (p=0; OR [95% CI]=3.14 [1.75 to 5.62]) were associated with increased risk of death following COVID-19 infection. Increased risk of hospital admissions in T2DM individuals was determined for 11 to 15 medications (p=0.01; OR [95% CI]=1.34 [1.06 to 1.69]) and above. This was independent of comorbidities, metabolic and demographic factors. For T1DM there was no association of polypharmacy with hospital admission. Respiratory, cardiovascular/cerebrovascular and gastrointestinal conditions were associated with increased risk of hospital admissions and deaths in T2DM (p>0.001). Conclusion We have shown in T2DM an independent association of number of medications taken from 11 upwards with adverse health consequences following COVID-19 infection. We also found that individuals with diabetes develop comorbidities that were common across both T1DM and T2DM. This study has laid the foundation for future investigations into the way that complex pharmacological interactions may influence clinical outcomes in people with T2DM. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Turing-Manchester Feasibility Project Funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Greater Manchester Care Record (GMCR) review board (overseen by Health Innovation Manchester) gave ethical approval for this work (ref: IDCR-RQ-046). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets generated during and analysed during the current study are not publicly available as all data access is subject to review by Health Innovation Manchester.