medwireNews: Research shows that the risk of COVID-19 mortality in people with type 2 diabetes depends only slightly on which antiglycemic medication they are taking at the time.
And the researchers believe that these small differences between the classes “are likely due to confusion by indication given the use of different classes of drugs in the early and late stages of the course of type 2 diabetes disease.”
The study, published in The Lancet Diabetes & Endocrinology, included data from 2,851,465 people with type 2 diabetes identified in the National Diabetes Audit of England.
By linking this data with hospital records and death records, Kamlesh Khunti (Leicester General Hospital, UK) and colleagues found that 0.5% of the cohort died between February and August 2020, with COVID-19 listed as the primary or secondary cause of death. This corresponded to a COVID-19 related death rate of 8.9 per 1000 person-years.
“Given the disproportionate contribution of people with diabetes to the deaths associated with COVID-19 (up to a third of all deaths in some countries), the relationship between glucose-lowering drugs and COVID-19 is a major issue for people with diabetes, clinicians and women policy makers, ”say the researchers.
After adjusting baseline characteristics, the team found some variation in COVID-19 mortality risk depending on the class of diabetes medication people were prescribed.
In particular, the use of metformin, sodium glucose cotransporter (SGLT) 2 inhibitors, or sulfonylureas was associated with a significantly reduced risk, with a reduction between 6% and 23% while this class of drug was not taken.
The use of glucagon-like peptide-1 receptor agonists, α-glucosidase inhibitors, or meglitinids had no association with the risk of COVID-19 mortality, whereas the use of dipeptidyl peptidase (DPP) -4 inhibitors or insulin had an increased risk of 7 associated was% and 42%, respectively.
“We interpret these results as an indication that there is still no clear indication that a modifiable risk factor – glucose control – or other potential non-glucose-related benefits of certain drugs could be compromised by stopping or changing diabetes medication in people with type 2 diabetes daily practice, ”conclude the researchers.
The author of a linked comment, Guntram Schernthaner (Rudolfstiftung Hospital Vienna, Austria) agrees with her view that the observed differences in mortality risk are caused by confusion remaining for 70 years and have decreased kidney function than those taking an SGLT2 inhibitor.
In light of what has been learned so far, he suggests that “Recommendations on the use of glucose lowering drugs by people with type 2 diabetes during the COVID-19 pandemic could now become more liberal, allowing the use of all glucose lowering drugs in stable situations”.
However, Schernthaner emphasizes: “Regardless of the choice of therapy, strict management of cardiovascular risk factors and strict blood sugar control are of crucial importance for patients with diabetes and COVID-19.”
medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
April 1, 2021: The coronavirus pandemic affects all health professionals around the world. During this difficult time, Medicine Matters focuses on disseminating the latest data to aid you in your research and clinical practice based on the scientific literature. We will update the information we post on the website as soon as the data is published. However, the latest guidelines in your country can be found in your own professional and regulatory guidelines.
Lancet Diabetes Endocrinol 2021; doi: 10.1016 / S2213-8587 (21) 00050-4
Lancet Diabetes Endocrinol 2021; doi: 10.1016 / S2213-8587 (21) 00059-0