Led by John Buse, MD, PhD, and Anna Kahkoska, MD, PhD, this analysis showed that the use of GLP1-RA and SGLT2i drugs for type 2 diabetes in hospitalized COVID-19 patients with a lower death rate and other adverse outcomes.
CHAPEL HILL, NC – Diabetes is one of the most heavily associated comorbidities with 2019 Severe Coronavirus Disease (COVID-19) in the United States, and data from the early stages of the pandemic suggest that people have type 2 diabetes were at twice the risk of dying from COVID -19, as well as a higher risk of hospitalization and intensive care.
The National COVID Collaborative (N3C), a partnership of NIH Clinical and Translational Science Award Program Hubs, conducted a study of data from 12,446 people with type 2 diabetes who tested positive for COVID-19 in 2020. These scientists found that people treated with certain types of diabetes medication did better than those treated with another type of medication.
Anna Kahkoska, MD, PhD
This research was published in Diabetes Care, the journal of the American Diabetes Association. The lead author is John Buse, MD, PhD, co-director of the North Carolina Translational and Clinical Sciences (NC TraCS) Institute at UNC and director of the UNC Diabetes Research Center. The lead author is Anna Kahkoska, MD, PhD, Assistant Professor in the UNC Department of Nutrition at the UNC Gillings School of Global Public Health and the UNC School of Medicine.
Two classes of blood sugar lowering drugs – glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) – have been used in previous large studies of cardiovascular, cardiovascular, heart failure, and renal outcomes in populations with high risk of cardiorenal events. The benefits associated with these drugs appear to be most pronounced in those with type 2 diabetes and comorbid cardiovascular disease, heart failure, chronic kidney disease, and obesity, diseases that are also at the highest risk for severe COVID-19.
In addition, scientists have speculated about plausible mechanisms for the protective effects of GLP1-RA and SGLT2i in COVID-19, regardless of their glycemic effects. However, it is unknown how the use of new drugs is related to the severity of COVID-19.
“Our goal was to characterize the association of premorbid use of GLP1-RA and SGLT2i with COVID-19 results,” said Buse, Verne S. Caviness Distinguished Professor of Medicine and Head of Endocrinology at the UNC School of Medicine. “The study hypothesis was that the use of both drug classes would be associated with improved results in the context of a COVID-19 infection. And characterizing these associations could reveal treatment strategies to improve outcomes for a population at high risk for COVID-19-associated mortality. “
For the study, the researchers selected people who use dipeptidyl peptidase-4 inhibitors (DPP4i) as a comparison group for people taking GLP1-RA or SGLT2i drugs, because DPP4i drugs continue to be used after starting metformin treatment Second line therapy can be considered and has been suggested to be safe or useful in other real world analyzes during COVID times.
To determine the respective associations of the use of premorbid glucagon-like peptide 1 receptor agonist (GLP1-RA) and sodium glucose cotransporter-2 inhibitor (SGLT2i) compared to the premorbid use of dipeptidyl peptidase-4 Inhibitor (DPP4i) with the severity of the results in severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2).
Of the 12,446 people, the 60 day mortality was 3.11%, with 2.06% using GLP1-RA, 2.32% using SGLT2i, and 5.67% using DPP4i . Both the use of GLP1-RA and SGLT2i were associated with a lower 60-day mortality compared to the use of DPP4i. The use of both GLP1-RA and SGLT2i drugs was also associated with decreased all-cause mortality, emergency room visits, and hospital stays, although those taking DPP4i drugs were older and generally sicker.
N3C is a COVID research platform funded by the National Center for Advancing Translational Sciences (NCATS) of the National Institute of Health that contains data from over 2 million people who test positive for COVID. The North Carolina Translational and Clinical Sciences (TraCS) Institute played a key role in the development of N3C and supports efforts to use the data to develop better treatment and prevention programs for COVID.
Other authors of the Diabetes Care Paper are Trine Julie Abrahamsen, G. Caleb Alexander, Tellen D. Bennett, Christopher G. Chute, Melissa A. Haendel, Klara R. Klein, Hemalkumar Mehta, Joshua D. Miller, Richard A. Moffitt, An Striker and Kajsa Kvist.
