Real‐world risk factors of confirmed or probable COVID‐19 in Americans with diabetes: A prospective, community‐based study (iNPHORM)

INTRODUCTION: Americans with diabetes are clinically vulnerable to worse COVID‐19 outcomes; thus, insight into how to prevent infection is imperative. Using longitudinal, prospective data from the real‐world iNPHORM study, we identify the intrinsic and extrinsic risk factors of confirmed or probable COVID‐19 in people with type 1 or 2 diabetes. METHODS: The iNPHORM study recruited 1206 Americans (18–90 years) with insulin‐ and/or secretagogue‐treated type 1 or 2 diabetes from a probability‐based internet panel. Online questionnaires (screener, baseline and 12 monthly follow‐ups) assessed COVID‐19 incidence and various plausible intrinsic and extrinsic factors. Multivariable Cox regression was used to model the rate of COVID‐19 (confirmed or probable). Risk factors were selected using a repeated backwards‐selection ‘voting’ procedure. RESULTS: A sub‐sample of 817 iNPHORM participants (type 1 diabetes: 16.9%; age: 52.1 [SD: 14.2] years; female: 50.2%) was analysed between May 2020 and March 2021. During this period, 13.7% reported confirmed or probable COVID‐19. Age, body mass index, number of chronic comorbidities, most recent A1C, past severe hypoglycaemia, and employment status were selected in our final model. Body mass index ≥30 kg/m(2) versus <30 kg/m(2) (HR 1.63 [1.05; 2.52](95% CI)), and increased number of comorbidities (HR 1.16 [1.05; 1.27](95% CI)) independently predicted COVID‐19 incidence. Marginally significant effects were observed for overall A1C (p = .06) and employment status (p = .07). CONCLUSIONS: This is the first US‐based epidemiologic investigation to characterize community‐based COVID‐19 susceptibility in diabetes. Our results reveal specific and promising avenues to prevent COVID‐19 in this at‐risk population. ClinicalTrials.gov Identifier: NCT04219514.