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Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with Type 2 Diabetes Mellitus in the United States

Boye et al., Diabetes Therapy, doi:10.1007/s13300-021-01110-1
Jul 2021  
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Hospitalization 10% Improvement Relative Risk Metformin for COVID-19  Boye et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 9,531 patients in the USA Lower hospitalization with metformin (p=0.0000028) c19early.org Boye et al., Diabetes Therapy, July 2021 Favorsmetformin Favorscontrol 0 0.5 1 1.5 2+
Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020, now with p < 0.00000000001 from 99 studies.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 112 treatments. c19early.org
Retrospective 9531 COVID+ diabetes patients in the USA, showing lower risk of hospitalization with existing biguanides treatment (defined as mainly metformin in the abstract and entirely metformin in the text).
risk of hospitalization, 10.0% lower, RR 0.90, p < 0.001, treatment 2,067 of 4,250 (48.6%), control 3,196 of 5,281 (60.5%), NNT 8.4, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Boye et al., 18 Jul 2021, retrospective, USA, peer-reviewed, 14 authors.
This PaperMetforminAll
Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with Type 2 Diabetes Mellitus in the United States
Kristina S Boye, Elif Tokar Erdemir, Nathan Zimmerman, Abraham Reddy, Brian D Benneyworth, Matan C Dabora, Emily R Hankosky, M Angelyn Bethel, Callahan Clark, Cody J Lensing, Scott Sailer, Ramira San Juan, Robert J Heine, Lida Etemad
Diabetes Therapy, doi:10.1007/s13300-021-01110-1
Introduction: Diabetes has been identified as a high-risk comorbidity for COVID-19 hospitalization. We evaluated additional risk factors for COVID-19 hospitalization and in-hospital mortality in a nationwide US database. Methods: This retrospective study utilized the UnitedHealth Group Clinical Discovery Database (January 1, 2019-July 15, 2020) containing de-identified nationwide administrative claims, SARS-CoV-2 laboratory test results, and COVID-19 inpatient admissions data. Logistic regression was used to understand risk factors for hospitalization and in-hospital mortality among people with type 2 diabetes (T2D) and in the overall population. Robustness of associations was further confirmed by subgroup and sensitivity analyses in the T2D population. Results: A total of 36,364 people were identified who were either SARS-CoV-2 ? or hospitalized for COVID-19. T2D was associated with increased COVID-19-related hospitalization and mortality. Factors associated with increased hospitalization risk were largely consistent in the overall population and the T2D subgroup, including age, male sex, and these top five comorbidities: dementia, metastatic tumor, congestive heart failure, paraplegia, and metabolic disease. Biguanides (mainly metformin) were consistently associated with lower odds of hospitalization, whereas sulfonylureas and insulins were associated with greater odds of hospitalization among people with T2D. Conclusion: In this nationwide US analysis, T2D was identified as an independent risk factor for COVID-19 complications. Many factors conferred similar risk of hospitalization across both populations; however, particular diabetes medications may be markers for differential risk. The insights on comorbidities and medications may inform population health initiatives, including prevention efforts for high-risk patient populations such as those with T2D.
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Cell ' 'Metab. 2021;33(1):65-77.e2.', 'journal-title': 'Cell Metab'}, { 'key': '1110_CR35', 'doi-asserted-by': 'publisher', 'first-page': '1236', 'DOI': '10.3389/fimmu.2018.01236', 'volume': '9', 'author': 'F Ursini', 'year': '2018', 'unstructured': 'Ursini F, Russo E, Pellino G, et al. Metformin and autoimmunity: a “New ' 'Deal” of an old drug. Front Immunol. 2018;9:1236.', 'journal-title': 'Front Immunol'}, { 'key': '1110_CR36', 'doi-asserted-by': 'publisher', 'first-page': '108183', 'DOI': '10.1016/j.diabres.2020.108183', 'volume': '164', 'author': 'S Sharma', 'year': '2020', 'unstructured': 'Sharma S, Ray A, Sadasivam B. Metformin in COVID-19: a possible role ' 'beyond diabetes. Diabetes Res Clin Pract. 2020;164:108183.', 'journal-title': 'Diabetes Res Clin Pract'}, { 'issue': '11', 'key': '1110_CR37', 'doi-asserted-by': 'publisher', 'first-page': 'e901', 'DOI': '10.1093/cid/ciaa1592', 'volume': '72', 'author': 'J Xu', 'year': '2021', 'unstructured': 'Xu J, Teng Y, Shang L, Gu X, Fan G, Chen Y, Tian R, Zhang S, Cao B. The ' 'effect of prior ACEI/ARB treatment on COVID-19 susceptibility and ' 'outcome: a systematic review and meta-analysis. Clin Infect Dis. ' '2021;72(11):e901–13.', 'journal-title': 'Clin Infect Dis'}, { 'issue': '3', 'key': '1110_CR38', 'doi-asserted-by': 'publisher', 'first-page': 'e213594', 'DOI': '10.1001/jamanetworkopen.2021.3594', 'volume': '4', 'author': 'R Baral', 'year': '2021', 'unstructured': 'Baral R, Tsampasian V, Debski M, Moran B, Garg P, Clark A, Vassiliou VS. ' 'Association between renin-angiotensin-aldosterone system inhibitors and ' 'clinical outcomes in patients with COVID-19: a systematic review and ' 'meta-analysis. JAMA Netw Open. 2021;4(3):e213594.', 'journal-title': 'JAMA Netw Open'}, { 'issue': '5', 'key': '1110_CR39', 'doi-asserted-by': 'publisher', 'first-page': '2709', 'DOI': '10.1007/s12325-021-01704-y', 'volume': '38', 'author': 'M Cugno', 'year': '2021', 'unstructured': 'Cugno M, Gualtierotti R, Casazza G, Tafuri F, Ghigliazza G, Torri A, et ' 'al. Mortality in PATIENTS with COVID-19 on renin angiotensin system ' 'inhibitor long-term treatment: an observational study showing that ' 'things are not always as they seem. Adv Ther. 2021;38(5):2709–16.', 'journal-title': 'Adv Ther'}], 'container-title': ['Diabetes Therapy'], 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1007/s13300-021-01110-1.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1007/s13300-021-01110-1/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1007/s13300-021-01110-1.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 8, 5]], 'date-time': '2021-08-05T10:02:14Z', 'timestamp': 1628157734000}, 'score': 1, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 7, 18]]}, 'references-count': 39, 'journal-issue': {'issue': '8', 'published-print': {'date-parts': [[2021, 8]]}}, 'alternative-id': ['1110'], 'URL': 'http://dx.doi.org/10.1007/s13300-021-01110-1', 'relation': {}, 'ISSN': ['1869-6953', '1869-6961'], 'issn-type': [{'value': '1869-6953', 'type': 'print'}, {'value': '1869-6961', 'type': 'electronic'}], 'subject': ['Endocrinology, Diabetes and Metabolism', 'Internal Medicine'], 'published': {'date-parts': [[2021, 7, 18]]}, 'assertion': [ { 'value': '28 April 2021', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '28 June 2021', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '18 July 2021', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}]}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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