Outcome of COVID-19 Positive Patients with type 2 Diabetes and Polypharmacy: an Examination of a Tertiary Hospital Cohort

Background: COVID-19-positive patients are at increased risk of adverse clinical outcomes, with type 2 diabetes cohorts at substantially higher risk compared to the general population. The additional role of diabetic and non-diabetic polypharmacy in these patients' clinical course has remained unexamined. In this study we have comprehensively examined the role of polypharmacy in the determination of mortality outcomes in patients with COVID-19 clinical syndrome. Methods: We retrospectively examined case notes and electronic records of N = 497 patients with type 2 diabetes and COVID-19 infection. We ascertained the number of medications each patient was taking and used this to categorize the study cohort into diabetic [n = 246] (5 or more diabetic medications), and non-diabetic polypharmacy [n = 251] (5 or more non-diabetic medications). The primary outcome was the need for intensive care admission between the two groups. Results: In patients with “non-diabetic polypharmacy” (>5 medications), advancing age, and higher HBA1c levels, were associated with increased risk of Intensive care admission (OR 1.06 [CI 1.03-1.07], P = <0001), (OR 1.01 [CI 1.01- 1.20], P 0.017), respectively. Patients taking 5 or more non-diabetic medications had an increased likelihood of admission into the intensive care unit compared to those on lower medication thresholds (OR = 1.7; CI = 1.1 to 1.3; p-value = <0.0006). Conclusion: In an inpatient cohort of type 2 diabetic patients with COVID-19, non-diabetic polypharmacy was associated with a multiplicative risk of intensive care admissions. This will necessitate the need for periodic medication reviews in these cohorts of patients to mitigate these potential risks and improve clinical outcomes.