Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis

Nguyen, Nam Nhat; Ho, Dung Si; Nguyen, Hung Song; Ho, Dang Khanh Ngan; Li, Chung‐Yi; Lin, Chia-Yuan; Chiu, Hung-Wen; Chen, Yang Ching

doi:10.1016/j.metabol.2022.155196

Cited by 59 publications

(78 citation statements)

References 93 publications

(68 reference statements)

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“…In addition to the already known anti-inflammatory properties, primarily on endothelial function, SGLT2 inhibitors therapy could play a protective role in COVID-19-related organ failure [ 25 ]. The meta-analysis performed by Nguyen et al showed a significant mortality reduction in individuals with T2DM treated with SGLT2 inhibitors previous to hospital admission (OR = 0.60 [0.40–0.88]) [ 62 ]. Nevertheless, a double-blind, placebo-controlled clinical trial with dapagliflozin in COVID-19 hospitalized patients with one or more cardiometabolic risk factors did not show a significant reduction in organ dysfunction or death, or in clinical recovery [ 63 ].…”

Section: How Antidiabetic Treatment Influences Sars-cov-2 Infectionmentioning

confidence: 99%

Type 2 Diabetes Mellitus and COVID-19: A Narrative Review

et al. 2022

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Type-2 diabetes mellitus (T2DM) is a chronic metabolic disorder. The incidence and prevalence of patients with T2DM are increasing worldwide, even reaching epidemic values in most high- and middle-income countries. T2DM could be a risk factor of developing complications in other diseases. Indeed, some studies suggest a bidirectional interaction between T2DM and COVID-19. A growing body of evidence shows that COVID-19 prognosis in individuals with T2DM is worse compared with those without. Moreover, various studies have reported the emergence of newly diagnosed patients with T2DM after SARS-CoV-2 infection. The most common treatments for T2DM may influence SARS-CoV-2 and their implication in infection is briefly discussed in this review. A better understanding of the link between TD2M and COVID-19 could proactively identify risk factors and, as a result, develop strategies to improve the prognosis for these patients.

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Section: How Antidiabetic Treatment Influences Sars-cov-2 Infectionmentioning

confidence: 99%

Type 2 Diabetes Mellitus and COVID-19: A Narrative Review

et al. 2022

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“…For instance, among 64 892 veterans with diabetes and COVID-19, insulin use was associated with higher odds of hospitalization and risk of death 25. A meta-analysis of 33 studies reported an OR of 1.70 (95% CI 1.33 to 2.19) as comparing patients on insulin to non-users 26. Because the coronavirus replicates faster in a high glucose environment and glucose fluctuations make it more challenging to treat COVID-19,2 patients with uncontrolled diabetes may experience more severe COVID-19 outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In a nationwide observational cohort study in England, metformin use was associated with 23% reduced mortality in people with type 2 diabetes 25. A meta-analysis reported a pooled OR of 0.54 (95% CI 0.47 to 0.62) for metformin use and mortality 26. Several potential mechanisms might explain the protective effect of metformin, either by reducing the likelihood of SARS-CoV-2 infection or by decreasing COVID-19 severity.…”

Section: Discussionmentioning

confidence: 99%

Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland

Yeh

Kraschnewski

Kong

et al. 2022

BMJ Open Diab Res Care

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ObjectiveTo identify the demographic and clinical characteristics associated with adverse COVID-19 outcomes across a 12-month period in 2020 and 2021.Research design and methodsWe conducted a retrospective cohort study using electronic health records from five academic health systems in Pennsylvania and Maryland, including patients with COVID-19 with type 2 diabetes or at risk of type 2 diabetes. Patients were classified based on 30-day outcomes: (1) no hospitalization; (2) hospitalization only; or (3) a composite measure including admission to the intensive care unit (ICU), intubation, or death. Analyses were conducted in patients with type 2 diabetes and patients at risk of type 2 diabetes separately.ResultsWe included 15 725 patients with COVID-19 diagnoses between March 2020 and February 2021. Older age and higher Charlson Comorbidity Index scores were associated with higher odds of adverse outcomes, while COVID-19 diagnoses later in the study period were associated with lower odds of severe outcomes. In patients with type 2 diabetes, individuals on insulin treatment had higher odds for ICU/intubation/death (OR=1.59, 95% CI 1.27 to 1.99), whereas those on metformin had lower odds (OR=0.56, 95% CI 0.45 to 0.71). Compared with non-Hispanic White patients, Hispanic patients had higher odds of hospitalization in patients with type 2 diabetes (OR=1.73, 95% CI 1.36 to 2.19) or at risk of type 2 diabetes (OR=1.77, 95% CI 1.43 to 2.18.)ConclusionsAdults who were older, in racial minority groups, had multiple chronic conditions or were on insulin treatment had higher risks for severe COVID-19 outcomes. This study reinforced the urgency of preventing COVID-19 and its complications in vulnerable populations.Trial registration numberNCT02788903.

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“…Both Type 1 and type 2 diabetes are frequently identified medical comorbidities in patients with severe COVID-19 infection with poor clinical outcomes[ 5 , 6 ]. Diabetic patients treated with insulin prior to hospitalization also had poor outcomes[ 7 ]. Hyperglycemia (fasting blood glucose more than 125 mg/dL) is identified as an independent predictor of increased mortality in hospitalized patients without prior diagnosis of diabetes[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges in hyperglycemia management in critically ill patients with COVID-19

Kethireddy¹,

Gandhi²,

Kichloo³

et al. 2022

WJCCM

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Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay. Data from the corona virus disease 2019 (COVID-19) pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality. The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance, critical illness hyperglycemia (stress- induced hyperglycemia) secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action, acute cytokine storm and pancreatic cell dysfunction. Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state. Management of hyperglycemia in COVID-19 is often complicated by use of steroids, prolonged total parenteral or enteral nutrition, frequent acute hyperglycemic events, and restrictions with fluid management due to acute respiratory distress syndrome. While managing hyperglycemia special attention should be paid to mode of insulin delivery, frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment. In this article we describe the pathophysiology of hyperglycemia, challenges encountered in managing hyperglycemia, and review some potential solutions to address them.

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Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis

Cited by 59 publications

References 93 publications

Type 2 Diabetes Mellitus and COVID-19: A Narrative Review

Type 2 Diabetes Mellitus and COVID-19: A Narrative Review

Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland

Challenges in hyperglycemia management in critically ill patients with COVID-19

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