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

Abstract 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.