Use of DPP4i reduced odds of clinical deterioration and hyperinflammatory syndrome in COVID-19 patients with type 2 diabetes: Propensity score analysis of a territory-wide cohort in Hong Kong

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

doi:10.1016/j.diabet.2021.101307

Cited by 9 publications

(9 citation statements)

References 42 publications

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“…Patients with T2DM were captured using the International Classification of Primary Care, Version 2 (ICPC2) code T90 or the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Clinical Modification (ICD-9-CM) codes 250.x0 or 250.x2. This cohort has been used for studying pharmacoepidemiology of drug treatment for COVID-19 ( 14 ).…”

Section: Methodsmentioning

confidence: 99%

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

Lui

et al. 2022

Front. Endocrinol.

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AimThis study was conducted in order to evaluate the association between metformin use and clinical outcomes in type 2 diabetes mellitus (T2DM) patients hospitalized with coronavirus disease 2019 (COVID-19).MethodsPatients with T2DM with confirmed diagnosis of COVID-19 and admitted between January 21, 2020, and January 31, 2021 in Hong Kong were identified in our cohort. Exposure was defined as metformin use within 90 days prior to admission until hospital discharge for COVID-19. Primary outcome was defined as clinical improvement of ≥1 point on the WHO Clinical Progression Scale (CPS). Other outcomes were hospital discharge, recovery, in-hospital death, acidosis, hyperinflammatory syndrome, length of hospitalization, and changes in WHO CPS score.ResultsMetformin use was associated with greater odds of clinical improvement (OR = 2.74, p = 0.009), hospital discharge (OR = 2.26, p = 0.009), and recovery (OR = 2.54, p = 0.005), in addition to lower odds of hyperinflammatory syndrome (OR = 0.71, p = 0.021) and death (OR = 0.41, p = 0.010) than control. Patients on metformin treatment had a shorter hospital stay (−2.76 days, p = 0.017) than their control counterparts. The average WHO CPS scores were significantly lower in metformin users than non-users since day 15 (p < 0.001). However, metformin use was associated with higher odds of acidosis.ConclusionsMetformin use was associated with lower mortality and lower odds for hyperinflammatory syndrome. This provides additional insights into the potential mechanisms of the benefits of metformin use in T2DM patients with COVID-19.

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Section: Methodsmentioning

confidence: 99%

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

Lui

et al. 2022

Front. Endocrinol.

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“…Seven studies are included in the analysis of ICU admission and/or mechanical ventilation 8,11,13,18,23,26,29 . The pooled finding indicated DPP‐4i was associated with a statistically significant increase in ICU admission and/or mechanical ventilation in comparison with nonuse of DPP‐4i (RR: 1.24, 95% CI: 1.04, 1.48, p = .02) with substantial heterogeneity ( I 2 = 68%, p = .005) (Figure S9 and S10).…”

Section: Resultsmentioning

confidence: 99%

Noninsulin‐based antihyperglycemic medications in patients with diabetes and COVID‐19: A systematic review and meta‐analysis

Nassar

Abosheaishaa

Singh

et al. 2023

Journal of Diabetes

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Background: Patients with diabetes are more likely to suffer COVID-19 complications. Using noninsulin antihyperglycemic medications (AGMs) during COVID-19 infection has proved challenging. In this study, we evaluate different noninsulin AGMs in patients with COVID-19.Methods: We searched Medline, Embase, Web of Science, and Cochrane on 24 January 2022. We used the following keywords (COVID-19) AND (diabetes mellitus) AND (antihyperglycemic agent). The inclusion criteria were studies reporting one or more of the outcomes. We excluded non-English articles, case reports, and literature reviews. Study outcomes were mortality, hospitalization, and intensive care unit (ICU) admission. Results: The use of metformin rather than other glucose-lowering medications was associated with statistically significant lower mortality (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.47, 0.77, p < .001). Dipeptidyl peptidase-4 inhibitor (DPP-4i) use was associated with statistically significantly higher hospitalization risk (RR: 1.44, 95% CI: 1.23, 1.68, p < .001) and higher risk of ICU admissions and/or mechanical ventilation vs nonusers (RR: 1.24, 95% CI: 1.04, 1.48, p < .02). There was a statistically significant decrease in hospitalization for SGLT-2i users vs nonusers (RR: 0.89, 95% CI: 0.84-0.95, p < .001). Glucagon-like peptide-1 receptor agonist (GLP-1RA) use was associated with a statistically significant decrease in mortality

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“…Likewise, it was shown that sitagliptin reduced inflammation and chronic immune cell activation in HIV-infected adults [ 152 ]. In COVID-19 patients with T2DM, the use of DPP4 inhibitors reduced odds of clinical deterioration and hyperinflammatory syndrome [ 153 ]. In a recent meta-analysis addressing the potential impact of DPP4 inhibitors on COVID-19-related death, it was demonstrated that when they were administered in the inpatient setting, DPP4 inhibitors decreased the risk for COVID-19-related death by 50% [ 154 ].…”

Section: Resultsmentioning

confidence: 99%

Role of Dipeptidyl Peptidase-4 (DPP4) on COVID-19 Physiopathology

et al. 2022

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DPP4/CD26 is a single-pass transmembrane protein with multiple functions on glycemic control, cell migration and proliferation, and the immune system, among others. It has recently acquired an especial relevance due to the possibility to act as a receptor or co-receptor for SARS-CoV-2, as it has been already demonstrated for other coronaviruses. In this review, we analyze the evidence for the role of DPP4 on COVID-19 risk and clinical outcome, and its contribution to COVID-19 physiopathology. Due to the pathogenetic links between COVID-19 and diabetes mellitus and the hyperinflammatory response, with the hallmark cytokine storm developed very often during the disease, we dive deep into the functions of DPP4 on carbohydrate metabolism and immune system regulation. We show that the broad spectrum of functions regulated by DPP4 is performed both as a protease enzyme, as well as an interacting partner of other molecules on the cell surface. In addition, we provide an update of the DPP4 inhibitors approved by the EMA and/or the FDA, together with the newfangled approval of generic drugs (in 2021 and 2022). This review will also cover the effects of DPP4 inhibitors (i.e., gliptins) on the progression of SARS-CoV-2 infection, showing the role of DPP4 in this disturbing disease.

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Use of DPP4i reduced odds of clinical deterioration and hyperinflammatory syndrome in COVID-19 patients with type 2 diabetes: Propensity score analysis of a territory-wide cohort in Hong Kong

Cited by 9 publications

References 42 publications

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

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

Noninsulin‐based antihyperglycemic medications in patients with diabetes and COVID‐19: A systematic review and meta‐analysis

Role of Dipeptidyl Peptidase-4 (DPP4) on COVID-19 Physiopathology

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