COVID-19 mortality odds decrease for metformin customers with diabetes

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February 03, 2021

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Previous use of metformin has been linked to a tripling of COVID-19 mortality in people with diabetes, regardless of glucose profile and BMI, according to study data.

“It was a surprise to us that despite all the adjustments, mortality related to previous metformin use decreased so significantly, and that these beneficial effects were not associated with improvements in blood sugar control or obesity – blood sugar – HbA1c or BMI no lower for COVID-19 survivors. ” Anath Shalev, MD, Professor of Medicine and Director of the Comprehensive Diabetes Center at the University of Alabama at Birmingham, said Healio. “Even patients who did not take metformin had no more severe metabolic disease or diabetes than those who received metformin, as demonstrated by comparable or even lower BMI and HbA1c levels, suggesting that other mechanisms were responsible for these protective effects.”

Shalev is a Professor of Medicine and Director of the Comprehensive Diabetes Center at the University of Alabama at Birmingham.

Shalev and colleagues conducted a retrospective review of over 25,000 electronic health records, including 604 people who tested positive for COVID-19, between February 25 and June 22, 2020 at the University of Alabama in Birmingham. The researchers collected data on patient characteristics and comorbidities. Metformin and insulin were the two diabetes drugs analyzed in the study. The results of the study were published in Frontiers in Endocrinology.

Of the study population that tested positive for COVID-19, 52% were black, although blacks make up only 26% of the population in Alabama, and 36% were white, underscoring the racial differences of this pandemic. 70% of the COVID-19 positive study population already had hypertension, 61% were obese and 40% had diabetes. Those with diabetes who tested positive for COVID-19 had higher chances of mortality (OR = 3.62; 95% CI, 2.11-6.2; P <0.0001), and 67% of all deaths occurred in people with diabetes. In addition to diabetes, older age and males were associated with an increased risk of mortality, and no difference between type 1 and type 2 diabetes was observed.

Researchers analyzed patient use of insulin and metformin before testing positive for COVID-19. Metformin was found to reduce the likelihood of COVID-19 mortality (OR = 0.38; 95% CI, 0.17-0.87; P = 0.0221), while insulin did not affect the mortality rate. Of those who used metformin, the morality rate was 11%, which was comparable to the general death rate in the population and less than half the 24% death rate in people with diabetes who did not use metformin.

The association between metformin use and reduced COVID-19 mortality rates persisted after excluding patients with chronic kidney disease or chronic heart failure (OR = 0.17; 95% CI, 0.04-0.79; P = 0.0231). The mortality probability was also lower in men taking metformin (OR = 0.28; 95% CI, 0.09-0.88; P = 0.0286). After adjusting for age, gender, ethnicity, insulin use, obesity, and high blood pressure, those who took metformin were less likely to die than those who did not take metformin (OR = 0.33; 95% CI, 0.13-0.84 ; P = 0.021)).

“More than ever, it is important to follow general guidelines for the treatment of diabetes and not delay or stop metformin treatment in people with type 2 diabetes,” Shalev said. “Especially during this pandemic, when patients with diabetes are at a particularly high risk, this treatment can not only help manage diabetes but also reduce the risk of an undesirable outcome in the event of COVID-19 infection.”

For more informations:

Anath Shalev, MD, can be reached at shalev@uab.edu.

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