Effects of metformin, insulin on COVID-19 patients with pre-existed type 2 diabetes: A multicentral retrospective study

Cheng, Xueqi; Xin, Siyi; Chen, Yaqi; Li, Leyu; Chen, Wanjun; Li, Wenjia; Zhou, Baoan; Li, Chenxia; Gong, Yu; Li, Fēi; Duan, Peng; Zhou, Xingjian

doi:10.1016/j.lfs.2021.119371

Cited by 20 publications

(24 citation statements)

References 27 publications

(34 reference statements)

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“…Among the 31 studies included, these, 23 studies related to metformin ( 11 , 12 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ), 13 studies related to DPP-4i ( 23 , 28 , 29 , 32 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ), 5 studies related to sulfonylurea or glinides ( 23 , 29 , 36 , 41 , 46 ), 5 studies related to SGLT-2i ( 23 , 29 , 36 , 41 , 42 ) and 4 study related to GLP-1RA ( 23 , 29 , 42 , 46 ). Some of these studies included multiple outcomes to different medications.…”

Section: Resultsmentioning

confidence: 99%

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Han

Sun

et al. 2022

Archives of Medical Research

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Background and Aims During the current Coronavirus Disease 2019 (COVID-19) pandemic, patients with diabetes face disproportionately more. This study was performed to clarify anti-inflammatory effects of anti-diabetic agents on COVID-19 in patients with diabetes. Methods and Results Relevant literature was searched on 15 databases up to November 14, 2020 and was updated on April 13, 2021. The pooled ORs along with 95% CIs were calculated to evaluate combined effects. 31 studies with 66,914 patients were included in qualitative and quantitative synthesis. Meta-analysis showed that metformin was associated with a statistically significant lower mortality (pooled OR = 0.62, 95% CI, 0.50–0.76, p = 0.000) and poor composite outcomes (pooled OR = 0.83, 95% CI, 0.71–0.97, p = 0.022) in diabetic patients with COVID-19. Significance of slight lower mortality remained in sulfonylurea/glinides (pooled OR = 0.93, 95% CI, 0.89–0.98, p = 0.004), but of poor composite outcomes was not (pooled OR = 1.48, 95% CI, 0.61–3.60, p = 0.384). Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were associated with statistically non-significant lower mortality (pooled OR = 0.95, 95% CI, 0.72–1.26, p = 0.739) or poor composite outcomes (pooled OR = 1.27, 95% CI, 0.91–1.77, p = 0.162) of COVID-19 in diabetic patients. Conclusion Metformin might be beneficial in decreasing mortality and poor composite outcomes in diabetic patients infected with SARS-CoV-2. DPP-4 inhibitors, sulfonylurea/glinides, SGLT-2 inhibitors, and GLP-1RA wouldn't seem to be adverse. There's insufficient evidence to conclude effects of other anti-diabetic agents. Limited by retrospective characteristics, with relative weak capability to verify causality, more prospective studies, especially RCTs are needed. Registration number: PROSPERO-CRD42020221951.

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Section: Resultsmentioning

confidence: 99%

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Han

Sun

et al. 2022

Archives of Medical Research

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“…Chinese patients taking metformin prior to admission had a reduced percentage of death, however, due to lower number of patients it was not statistically significant (9.3% × 19.5%, p-value = 0.194) [ 14 ]. Other Chines study indicated that pre-metformin use associated with reduction in ICU admission in a dose-dependent way [ 34 ]. In a Belgium Centre the body mass index had no influences in outcome, while the use of metformin on admission had increased survival [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome and death risk of diabetes patients with Covid-19 receiving pre-hospital and in-hospital metformin therapies

Tamura

Said

Freitas

et al. 2021

Diabetol Metab Syndr

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Background COVID-19 has stroke Brazil harshly, deaths by COVID-19 in Brazil represent almost 13% of the total deaths by COVID-19 in the world, even though Brazilian population represents only 2.6% of the world population. Our aim in this study was to evaluate death and intubation outcomes and risk factors associated with COVID-19, and treatment options focusing on diabetes patients and the use of metformin pre-admission and during hospitalization. Methods In this Brazilian single-center study we evaluated 1170 patients hospitalized due to COVID-19. Diabetes patients (n = 188) were divided based on their use of pre-hospital and in-hospital metformin (non-met-group and met-group). Results In the total cohort most comorbidities were risk factors for orotracheal intubation and death. The use of chloroquine/hydroxychloroquine was significantly associated with increased death and intubation risk in uni- and multivariate analysis. Diabetes patients showed worst clinical feature compared with non-diabetes patients. In-hospital non-met-group had increased mortality (20.5%) compared to met-group (3.5%) (p = 0.0002) and univariable cox proportion hazard regression indicated in-hospital metformin reduced mortality (HR = 0.325, p = 0.035). Patients that used pre-hospital metformin showed lower severity parameters at hospital admission. (met-group: 2.45 ± 2.5; non-met-group: 4.25 ± 3.4). In all the groups older patients showed more severe clinical conditions and high risk of death and intubation. Conclusion Even though this is a single-center study, results from other reports have shown a similar trend, indicating that patients that used metformin during hospitalization have a better prognosis and reduced risk of death.

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“…In the CORONADO trial, regarding all available antidiabetic medications, only metformin treatment showed a reduced rate of death [ 17 ]. In a multicentre retrospective study, it has been shown that metformin treatment prior to admission to hospital was correlated with a decreased intensive care unit admission rate in a dose-dependent fashion [ 112 ]. In contrast, in a retrospective study, it was indicated that metformin therapy is associated with an increased severity of COVID-19 infection and with a higher number of life-threatening complications [ 113 ]; however, in another systematic review, it was shown that metformin might improve the clinical outcomes in diabetic patients with a mild to severe course of COVID-19 [ 114 ].…”

Section: Diabetes Treatment and Covid-19mentioning

confidence: 99%

“…It has been reported that patients with COVID-19 who use insulin have a higher risk of poor prognosis than noninsulin users [ 63 ]. Moreover, insulin treatment in hospitalised patients has been linked to increased invasive ventilation [ 112 ]. However, it should be noted that these groups might have been incomparable, as insulin is usually the only recommended treatment in the severe course of infections and because in an advanced stage of diabetes with some comorbidities other glucose-lowering medications are contraindicated [ 63 ].…”

Section: Diabetes Treatment and Covid-19mentioning

confidence: 99%

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Therapy of Type 2 Diabetes in Patients with SARS-CoV-2 Infection

Bielka

Przezak

Pawlik

2021

IJMS

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COVID-19 infection poses an important clinical therapeutic problem, especially in patients with coexistent diseases such as type 2 diabetes. Potential pathogenetic links between COVID-19 and diabetes include inflammation, effects on glucose homeostasis, haemoglobin deoxygenation, altered immune status and activation of the renin-angiotensin-aldosterone system (RAAS). Moreover, drugs often used in the clinical care of diabetes (dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, metformin and insulin) may influence the course of SARS-CoV-2 infection, so it is very important to verify their effectiveness and safety. This review summarises the new advances in diabetes therapy and COVID-19 and provides clinical recommendations that are essential for medical doctors and for patients suffering from type 2 diabetes.

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Effects of metformin, insulin on COVID-19 patients with pre-existed type 2 diabetes: A multicentral retrospective study

Cited by 20 publications

References 27 publications

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Outcome and death risk of diabetes patients with Covid-19 receiving pre-hospital and in-hospital metformin therapies

Therapy of Type 2 Diabetes in Patients with SARS-CoV-2 Infection

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