Are diabetes and its medications risk factors for the development of COVID-19? Data from a population-based study in Sicily

Silverii, Giovanni Antonio; Monami, Matteo; Cernigliaro, Achille; Vigneri, Enrica; Guarnotta, Valentina; Scondotto, Salvatore; Allotta, Vincenza A.; Conti, Michela; Giordano, Carla; Mannucci, Edoardo

doi:10.1016/j.numecd.2020.09.028

Cited by 40 publications

(55 citation statements)

References 10 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There were 4,477 patients from 9 studies in this systematic review and meta-analysis [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ] [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ] [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ] [ Fig. 1 ].…”

Section: Resultsmentioning

confidence: 99%

“…Dipeptidyl peptidase-4 inhibitor inhibitor exerts anti-inflammatory, anti-fibrotic, and anti-adipogenic properties, which may be useful in delaying the progression to hyper-inflammation in severe COVID-19 cases [ [4] , [5] , [6] ]. A multicenter study have shown that DPP-4 inhibitor was associated with lower mortality [ 7 ], while other studies did not [ 8 , 9 ]. This study aims to synthesize evidence on DPP-4 inhibitor and mortality in COVID-19 patients and factors affecting it.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in coronavirus disease 2019 (COVID-19) – A systematic review, meta-analysis, and meta-regression

Rakhmat

Kusmala

Handayani

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

View full text Add to dashboard Cite

Background and aims This study aims to synthesize evidence on dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in COVID-19 patients and factors affecting it. Methods We performed a systematic literature search from PubMed, Scopus, and Embase databases from inception of databases up until 7 March 2021. Studies that met all of the following criteria were included: 1) observational studies or randomized controlled trials that report COVID-19 patients, 2) reporting DPP-4 inhibitor use, 3) mortality, and 4) mortality based on DPP-4 inhibitor use. The exposure was DPP-4 inhibitor, defined as DPP-4 inhibitor use that started prior to COVID-19 hospitalization. The control group was patients with no exposure to DPP-4 inhibitor. The outcome was mortality. The pooled effect estimate was reported as risk ratio (RR). Results There were 4,477 patients from 9 studies in this systematic review and meta-analysis. 31% of (15%, 46%) the patients use DPP-4 inhibitor. Mortality occurs in 23% (15%, 31%) of the patients. DPP-4 inhibitor was associated with lower mortality in patients with COVID-19 (RR 0.76 [0.60, 0.97], p = 0.030, I2: 44.5%, p = 0.072). Meta-regression analysis showed that the association between DPP-4 inhibitor and mortality was significantly affected by metformin (RR 1.02 [1.00, 1.04], p = 0.048) and angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) use (RR 1.04 [1.01, 1.07], p = 0.006), but not age (p = 0.759), sex (reference: male, p = 0.148), and hypertension (p = 0.218). Conclusion DPP-4 inhibitor use was associated with lower mortality in COVID-19 patients, and the association was weaker in patients who were also taking metformin and/or ACE inhibitors.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in coronavirus disease 2019 (COVID-19) – A systematic review, meta-analysis, and meta-regression

Rakhmat

Kusmala

Handayani

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

View full text Add to dashboard Cite

show abstract

“…After propensity score matching, the use of DPP4i was not associated with other adverse outcomes, such as need of ICU admission, mechanical ventilation, in-hospital complications, or long-time hospital stays [22]. A few other observational studies reported no association between DPP4i treatment and COVID-19-related mortality [23,24] or COVID-19 severity [25].…”

Section: Summary Of the Evidencementioning

confidence: 96%

Disentangling conflicting evidence on DPP-4 inhibitors and outcomes of COVID-19: narrative review and meta-analysis

Bonora

Avogaro

Fadini

2021

J Endocrinol Invest

View full text Add to dashboard Cite

Background The infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread all over the world, becoming pandemic. Several studies have shown that diabetes mellitus (DM) is an independent risk factor that increases mortality and other adverse outcomes of coronavirus disease-19 . Studies have suggested that SARS-CoV-2 may bind dipeptidyl peptidase-4 (DPP4) for entering cells of the respiratory tract. Besides, DPP4 takes part in immune system regulation. Thus, DPP-4 inhibitors (DPP4i) may play a role against COVID-19. Methods We focused on the impact of DPP4i treatment on COVID-19-related outcomes in people with DM. For this purpose, we conducted a systematic review and meta-analysis to summarize the existing evidence on this topic. Results Retrospective observational studies provide inconsistent results on the association between use of DPP4i and outcomes of COVID-19. While two studies reported significantly lower mortality rates among patients with DM who received DPP4i versus those who did not, a series of other studies showed no effect of DPP4i or even worse outcomes. A meta-analysis of 7 studies yielded a neutral estimate of the risk ratio of COVID-19-related mortality among users of DPP4i (0.81; 95% CI 0.57-1.15). Conclusion In the absence of randomized controlled trials, observational research available so far provides inconclusive results and insufficient evidence to recommend use of DPP4i against COVID-19.

show abstract

“…Pre-existing diabetes, compared to those without has accounted for 24% vs. 10.2% in a report from China [7] ; 28.8% vs. 6.2% and 7.8% vs. 2.7% in multicenter studies from US [22] , and China [44] ; 24% vs. 20% in a meta-analysis [39] , and 10.6% vs. 2.1% in a South Korean population-based study [12] . While in Sicily, although diabetes was not a risk factor for COVID-19, it was associated with a higher fatality [45] .…”

Section: Discussionmentioning

confidence: 78%

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

Satman

Demirci

Haymana

et al. 2021

Diabetes Research and Clinical Practice

View full text Add to dashboard Cite

Aims Type 2 diabetes mellitus (T2DM) is a risk factor for severe COVID-19. Our aim was to compare the clinical outcomes of patients with and without T2DM during the first hit of COVID-19 in Istanbul Methods A retrospective population-based study was conducted including all consecutive adult symptomatic COVID-19 cases. Patients were confirmed with rt-PCR; treated and monitored in accordance with standard protocols. The primary endpoints were hospitalization and 30-day mortality Results Of the 93,571 patients, 22.6% had T2DM, with older age and higher BMI. Propensity Score matched evaluation resulted in significantly higher rates of hospitalization (1.5-fold), 30-day mortality (1.6-fold), and pneumonia (1.4-fold). They revealed more severe laboratory deviations, comorbidities, and frequent drug usage than the Non-DM group. In T2DM age, pneumonia, hypertension, obesity, and insulin-based therapies were associated with an increased likelihood of hospitalization; whereas age, male gender, lymphopenia, obesity, and insulin treatment were considerably associated with higher odds of death Conclusions COVID-19 patients with T2DM had worse clinical outcomes with higher hospitalization and 30-day mortality rates than those without diabetes. Compared to most territories of the world, COVID-19 mortality was much lower in Istanbul, which may be associated with accessible healthcare provision and the younger structure of the population

show abstract

Are diabetes and its medications risk factors for the development of COVID-19? Data from a population-based study in Sicily

Cited by 40 publications

References 10 publications

Dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in coronavirus disease 2019 (COVID-19) – A systematic review, meta-analysis, and meta-regression

Dipeptidyl peptidase-4 (DPP-4) inhibitor and mortality in coronavirus disease 2019 (COVID-19) – A systematic review, meta-analysis, and meta-regression

Disentangling conflicting evidence on DPP-4 inhibitors and outcomes of COVID-19: narrative review and meta-analysis

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

Contact Info

Product

Resources

About