{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:15:43Z","timestamp":1783581343148,"version":"3.55.0"},"posted":{"date-parts":[[2026,7,6]]},"group-title":"Epidemiology","reference-count":43,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Allergy and Infectious Diseases","award":["1K01AI182501"],"award-info":[{"award-number":["1K01AI182501"]}]},{"DOI":"10.13039\/100000025","name":"NIMH","doi-asserted-by":"crossref","award":["R01131542"],"award-info":[{"award-number":["R01131542"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"crossref","award":["U54 GM115458"],"award-info":[{"award-number":["U54 GM115458"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Glucagon-like peptide-1 receptor agonist-based therapies (GLP) have recently emerged as promising treatments across a wide range of health conditions. These medications may have protective effects against severe long-term consequences of COVID-19 by promoting weight loss, exerting antihyperglycemic and anti-inflammatory effects, and providing cardiovascular and endothelial protection.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We evaluated electronic health record data from a retrospective cohort of individuals in the National Clinical Cohort Collaborative. We included individuals with type 2 diabetes mellitus and comorbid COVID-19 who were prescribed either GLP (treatment) or a sodium-glucose co-transporter 2 inhibitor (SGLT2i) and subsequently developed acute COVID-19 between October 1, 2021, and April 1, 2023. We compared the 12-month cumulative incidence of mortality and Long COVID (Long COVID diagnosis and probable Long COVID via computational phenotype) between groups. We applied targeted maximum likelihood estimation to compare outcome risks by exposure status, controlling for covariates of interest.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We analyzed data from 14,215 individuals with COVID-19 and comorbid type 2 diabetes (mean age, 60 years; mean BMI, 37). Compared to SGLT2i, a prescription for GLP medication was associated with a lower risk of mortality (adjusted risk ratio [aRR] 0.71; 95% CI 0.53, 0.95), but not Long COVID diagnosis (aRR 1.01; 95% CI 0.80, 1.27) or probable Long COVID (aRR 0.94; 95% CI 0.88, 1.01).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found that among individuals with type 2 diabetes and comorbid COVID-19, a prescription for GLP vs. SGLT2i medications was associated with a lower risk of mortality, but not Long COVID.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.03.26357246","type":"posted-content","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:05:14Z","timestamp":1783382714000},"source":"Crossref","is-referenced-by-count":0,"title":["GLP Medications and Severe Post-COVID-19 Outcomes Among Individuals with Type 2 Diabetes Mellitus"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6419-0008","authenticated-orcid":false,"given":"Zachary","family":"Butzin-Dozier","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin-Chiun","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, University of California, Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunwen","family":"Ji","sequence":"additional","affiliation":[{"name":"School of Public Health, University of California, Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manav","family":"Kumar","sequence":"additional","affiliation":[{"name":"School of Public Health, University of California, Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Jerrod","family":"Anzalone","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, NE, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6581-7754","authenticated-orcid":false,"given":"Eric","family":"Hurwitz","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena C.","family":"Patel","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Budhihartanto","sequence":"additional","affiliation":[{"name":"School of Public Health, University of California, Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B.","family":"Buse","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Johnson","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5858-2080","authenticated-orcid":false,"given":"Carolyn","family":"Bramante","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Wong","sequence":"additional","affiliation":[{"name":"Renaissance School of Medicine, Stony Brook University, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026070823350959000_2026.07.03.26357246v1.1","doi-asserted-by":"crossref","first-page":"ofaf533","DOI":"10.1093\/ofid\/ofaf533","article-title":"Global Prevalence of Long COVID, Its Subtypes, and Risk Factors: An Updated Systematic Review and Meta-analysis","volume":"12","year":"2025","journal-title":"Open Forum Infectious Diseases"},{"key":"2026070823350959000_2026.07.03.26357246v1.2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.698169"},{"key":"2026070823350959000_2026.07.03.26357246v1.3","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.dsx.2021.04.007","article-title":"Long COVID: an overview","volume":"15","year":"2021","journal-title":"Diabetes & Metabolic Syndrome: Clinical Research & Reviews"},{"key":"2026070823350959000_2026.07.03.26357246v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1648"},{"key":"2026070823350959000_2026.07.03.26357246v1.5","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-019-1797-8"},{"key":"2026070823350959000_2026.07.03.26357246v1.6","doi-asserted-by":"crossref","unstructured":"Galicia-Garcia, U. et al. 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