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DOI: 10.1136/bmjopen-2022-071475; PMCID: PMC10335498


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.

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BMJ Open





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MeSH Keywords

Humans; Adolescent; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Retrospective Studies; COVID-19; Case-Control Studies; SARS-CoV-2; Thromboembolism; Risk Factors


COVID-19; DIABETES & ENDOCRINOLOGY; Health informatics; Stroke; Thromboembolism


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