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  1. Tuan, Wen-Jan DHA, MS, MPH
  2. Lennon, Robert P. MD, JD
  3. Zhang, Alice MD
  4. Macherla, Ajay
  5. Zgierska, Aleksandra E. MD, PhD


Context: Diabetic neuropathy (DN) affects more than 50% of diabetic patients who are also likely to have compromised immune system and respiratory function, both of which can make them susceptible to the SARS-CoV-2 virus.


Objective: To assess the risk of severe COVID-19 illness among adults with DN, compared with those with no DN and those with no diabetes.


Setting: The analysis utilized electronic health records from 55 US health care organizations in the TriNetX research database.


Design: A retrospective cohort study.


Participants: The analysis included 882 650 adults diagnosed with COVID-19 in January 2020 to June 2021, including 16 641 with DN, 81 329 with diabetes with no neuropathy, and 784 680 with no diabetes.


Outcome Measures: The presence of health care utilization (admissions to emergency department, hospital, intensive care unit), 30-day mortality, clinical presentation (cough, fever, hypoxemia, dyspnea, or acute respiratory distress syndrome), and diagnostic test results after being infected affected by COVID-19.


Results: The DN cohort was 1.19 to 2.47 times more likely than the non-DN cohorts to utilize care resources, receive critical care, and have higher 30-day mortality rates. Patients with DN also showed increased risk (1.13-2.18 times) of severe symptoms, such as hypoxemia, dyspnea, and acute respiratory distress syndrome.


Conclusions: Patients with DN had a significantly greater risk of developing severe COVID-19-related complications than those with no DN. It is critical for the public health community to continue preventive measures, such as social distancing, wearing masks, and vaccination, to reduce infection rates, particularly in higher risk groups, such as those with DN.