Metformin Use in Relation to Clinical Outcomes and Hyperinflammatory Syndrome Among COVID-19 Patients With Type 2 Diabetes: A Propensity Score Analysis of a Territory-Wide Cohort

Wong, Carlos King Ho; Lui, David Tak Wai; Lui, Angel Y. C.; Low, Marshall C. H.; Kwok, Ashley C. Y.; Lau, Kristy T K; Au, Ivan Chi Ho; Xiong, Xi; Chung, Matthew S H; Lau, Eric H Y; Cowling, Benjamin J.

doi:10.3389/fendo.2022.810914

Cited by 4 publications

(3 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several retrospective cohort studies have demonstrated low mortality in patients receiving metformin. 15 17 24 25 In line with our findings, other meta-analysis have revealed a significantly lower mortality in patients receiving metformin. 7 26 Retrospective cohort studies have shown metformin use to be an independent factor associated with mortality.…”

Section: Discussionsupporting

confidence: 92%

“…1 Several studies have demonstrated high mortality rate in type 2 diabetes mellitus patients 1,5,6,24 ; however, the effect of antidiabetics on the mortality remains to be elucidated. 25 Thus, the present meta-analysis was conducted to assess the association of metformin use with mortality in COVID-19 patients. The present meta-analysis was based on data from nine studies on COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Metformin with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Parveen

Mishra

Luthra

et al. 2023

ANAMS

View full text Add to dashboard Cite

Studies have demonstrated high prevalence of mortality in coronavirus disease (COVID-19) patients with type 2 diabetes mellitus; however, the effects of antidiabetic pharmacotherapy on COVID-19 complications need further exploration. The aim of the study was to explore the association of metformin use and mortality in COVID-19 patients. A literature search was conducted using the databases Medline (via PubMed) and Cochrane Central Register of Controlled Trials until February 09, 2021. Nine studies were included in the meta-analysis, including 12,684 COVID-19 patients. The meta-analysis suggested 37% lower risk of mortality in patients receiving metformin (risk ratio: 0.63; 95% confidence interval: 0.50–0.78; p < 0.001). However, no significant difference in hospitalization days between the two groups (p = 0.197) was observed. The analysis revealed significantly lower risk of having obesity (p < 0.001), hypertension (p < 0.001), heart failure (p < 0.001), and cerebrovascular disease (p = 0.015) in the group receiving metformin. The analysis also demonstrated significantly lower risk of using anticoagulants (p = 0.015), diuretics (p < 0.001), and antiplatelets (p = 0.010) in patients receiving metformin. Our findings suggest that metformin use decreases mortality in COVID-19 patients. However, randomized studies demonstrating the consequences of metformin use are needed to understand the magnitude of the beneficial effects of metformin.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Association of Metformin with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Parveen

Mishra

Luthra

et al. 2023

ANAMS

View full text Add to dashboard Cite

show abstract

“…Regarding the use of oral antidiabetic agents, metformin should be stopped at admission but if and when the risk of lactic acidosis is considered low, it should be restarted since it appears to improve the outcome of COVID-19[ 12 , 15 , 16 ]. If used, the dose of metformin should be reduced in patients with estimated glomerular filtration rate (eGFR) between 30 and 45 mL/min and should be discontinued in patients with eGFR < 30 mL/min, liver failure, high risk for lactic acidosis and before iodine contrast imaging[ 17 ].…”

Section: Antidiabetic Treatmentmentioning

confidence: 99%

Considerations for management of patients with diabetes mellitus and acute COVID-19

Mougakou¹,

Kyziroglou²,

Tsankof³

et al. 2022

World J Diabetes

View full text Add to dashboard Cite

Diabetes mellitus (DM) is an independent risk factor for admission to intensive care unit and death in patients with coronavirus disease 2019 (COVID-19). On the other hand, medications used in the management of COVID-19 are potentially associated with increases in blood glucose levels and a higher incidence of infections. Accordingly, care of patients with DM and acute COVID-19 requires careful consideration of both diseases. Hyperglycemia and hypoglycemia are associated with adverse outcomes and therefore frequent measurement of blood glucose levels and a basal-bolus insulin regimen are required in most patients. Regarding the management of COVID-19, dexamethasone increases blood glucose levels and might also increase the risk for infections. On the other hand, limited data suggest that antiviral and immunomodulatory agents used in COVID-19 are not strongly associated with higher incidence of infections in this population. As knowledge evolves in this field, optimization of the management of both DM and COVID-19 will hopefully improve the outcome of these patients.

show abstract

Risk phenotypes of diabetes and association with COVID-19 severity and death: an update of a living systematic review and meta-analysis

Schlesinger,

Lang,

Christodoulou

et al. 2023

Diabetologia

View full text Add to dashboard Cite

Aims/hypothesis To provide a systematic overview of the current body of evidence on high-risk phenotypes of diabetes associated with COVID-19 severity and death. Methods This is the first update of our recently published living systematic review and meta-analysis. Observational studies investigating phenotypes in individuals with diabetes and confirmed SARS-CoV-2 infection with regard to COVID-19-related death and severity were included. The literature search was conducted from inception up to 14 February 2022 in PubMed, Epistemonikos, Web of Science and the COVID-19 Research Database and updated using PubMed alert to 1 December 2022. A random-effects meta-analysis was used to calculate summary relative risks (SRRs) with 95% CIs. The risk of bias was evaluated using the Quality in Prognosis Studies (QUIPS) tool and the certainty of evidence using the GRADE approach. Results A total of 169 articles (147 new studies) based on approximately 900,000 individuals were included. We conducted 177 meta-analyses (83 on COVID-19-related death and 94 on COVID-19 severity). Certainty of evidence was strengthened for associations between male sex, older age, blood glucose level at admission, chronic insulin use, chronic metformin use (inversely) and pre-existing comorbidities (CVD, chronic kidney disease, chronic obstructive pulmonary disease) and COVID-19-related death. New evidence with moderate to high certainty emerged for the association between obesity (SRR [95% CI] 1.18 [1.04, 1.34], n=21 studies), HbA1c (53–75 mmol/mol [7–9%]: 1.18 [1.06, 1.32], n=8), chronic glucagon-like peptide-1 receptor agonist use (0.83 [0.71, 0.97], n=9), pre-existing heart failure (1.33 [1.21, 1.47], n=14), pre-existing liver disease (1.40 [1.17, 1.67], n=6), the Charlson index (per 1 unit increase: 1.33 [1.13, 1.57], n=2), high levels of C-reactive protein (per 5 mg/l increase: 1.07 [1.02, 1.12], n=10), aspartate aminotransferase level (per 5 U/l increase: 1.28 [1.06, 1.54], n=5), eGFR (per 10 ml/min per 1.73 m2 increase: 0.80 [0.71, 0.90], n=6), lactate dehydrogenase level (per 10 U/l increase: 1.03 [1.01, 1.04], n=7) and lymphocyte count (per 1×109/l increase: 0.59 [0.40, 0.86], n=6) and COVID-19-related death. Similar associations were observed between risk phenotypes of diabetes and severity of COVID-19, with some new evidence on existing COVID-19 vaccination status (0.32 [0.26, 0.38], n=3), pre-existing hypertension (1.23 [1.14, 1.33], n=49), neuropathy and cancer, and high IL-6 levels. A limitation of this study is that the included studies are observational in nature and residual or unmeasured confounding cannot be ruled out. Conclusions/interpretation Individuals with a more severe course of diabetes and pre-existing comorbidities had a poorer prognosis of COVID-19 than individuals with a milder course of the disease. Registration PROSPERO registration no. CRD42020193692. Previous version This is a living systematic review and meta-analysis. The previous version can be found at https://link.springer.com/article/10.1007/s00125-021-05458-8 Funding The German Diabetes Center (DDZ) is funded by the German Federal Ministry of Health and the Ministry of Culture and Science of the State North Rhine-Westphalia. This study was supported in part by a grant from the German Federal Ministry of Education and Research to the German Center for Diabetes Research (DZD). Graphical Abstract

show abstract

Metformin Use in Relation to Clinical Outcomes and Hyperinflammatory Syndrome Among COVID-19 Patients With Type 2 Diabetes: A Propensity Score Analysis of a Territory-Wide Cohort

Cited by 4 publications

References 37 publications

Association of Metformin with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Association of Metformin with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Considerations for management of patients with diabetes mellitus and acute COVID-19

Risk phenotypes of diabetes and association with COVID-19 severity and death: an update of a living systematic review and meta-analysis

Contact Info

Product

Resources

About