Male sex, older age and pre-existing comorbidities (CVD, CKD and COPD), as well as the use of insulin, most of which are potential indicators for a more progressive course of diabetes, were associated with increased risk of COVID-19-related death and severity in individuals with diabetes and SARS-CoV-2, whereas metformin use had associations in the opposite direction. Here, INS is linked to chronic obstructive pulmonary disease.