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0 0.5 1 1.5 2+ Mortality 78% Improvement Relative Risk Clinical score 41% CT score 84% Metformin  Al-kuraishy et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Prospective study of 100 patients in Iraq (March - June 2020) Lower mortality (p=0.012) and improved recovery (p=0.0002) Al-kuraishy et al., European Review fo.., Dec 2023 Favors metformin Favors control

The potential therapeutic effect of metformin in type 2 diabetic patients with severe COVID-19

Al-kuraishy et al., European Review for Medical and Pharmacological Sciences, doi:10.26355/eurrev_202312_34583
Dec 2023  
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Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020
*, now known with p < 0.00000000001 from 84 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Prospective study of 60 hospitalized type 2 diabetes patients with COVID-19 on metformin monotherapy compared to 40 patients on other diabetes treatments, showing significantly lower inflammatory biomarkers, oxidative stress, and mortality, and improvements in radiological and clinical outcomes with metformin. Confounding due to differences in baseline characteristics may be significant.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with significant baseline differences.
risk of death, 77.8% lower, RR 0.22, p = 0.01, treatment 3 of 60 (5.0%), control 9 of 40 (22.5%), NNT 5.7.
relative clinical score, 40.8% better, RR 0.59, p < 0.001, treatment 57, control 31.
relative CT score, 84.0% better, RR 0.16, p < 0.001, treatment 57, control 31.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Al-kuraishy et al., 1 Dec 2023, prospective, Iraq, peer-reviewed, 10 authors, study period March 2020 - June 2020. Contact:,
This PaperMetforminAll
H M Al-Kuraishy, A I Al-Gareeb, A A El Kholy, E El-Khateeb, A Alexiou, M Papadakis, MD Engy Elekhnawy, N Alsubaie, R S Hamad, G E Batiha
OBJECTIVE: Type 2 diabetes mellitus (T2DM) is regarded as a chief risk factor for(coronavirus disease 2019 (COVID-19) owing to dysregulation of the expression of angiotensin-converting enzyme 2 (ACE2) and chronic low-grade inflammatory disorders. Metformin, an insulin-sensitizing agent for managing T2DM, has pleiotropic anti-inflammatory and oxidant potentials, which may lessen the risk of diabetic complications. So, we aimed to reveal the potential role of metformin monotherapy in treating T2DM patients with COVID-19. PATIENTS AND METHODS: In this prospective cohort study, 60 hospitalized T2DM patients with COVID-19 on metformin plus standard anti-COVID-19 treatments compared to 40 hospitalized T2DM patients with COVID-19 on other diabetic pharmacotherapy like insulin and sulfonylurea, were recruited. Inflammatory and oxidative stress biomarkers and radiological and clinical outcomes were assessed at admission time and at the time of discharge. RESULTS: The results of this study illustrated that metformin treatment in T2DM patients with COVID-19 was more effective in reducing inflammatory and oxidative stress biomarkers with significant amelioration of radiological scores and clinical outcomes compared to T2DM patients with COVID-19 on another diabetic pharmacotherapy. CONCLUSIONS: Our findings highlighted that metformin efficiently managed T2DM patients with COVID-19 by reducing inflammatory and oxidative stress with mitigating effects on the radiological scores and clinical outcomes.
Conflict of Interest The authors declare that they have no conflict of interests. Ethics Approval This study was approved scientific jury and the editorial board in the College of Medicine, Al-Mustansiriayiah University, Iraq, Baghdad (reference No. 34MTR on 20/2/2020). Informed Consent Informed consent was obtained from all individual participants included in the study. Authors' Contribution HMA and AAE performed the study, edited the main text, and approved the final edition of the manuscript. EEK, AA, MP, EE and GE-SB prepared the tables, wrote the main text, and approved the final edition of the manuscript. NA and RSH revised the manuscript. All authors approved the final edition of the manuscript.
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