Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes
Crouse et al.,
Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes,
Front. Endocrinol., doi:10.3389/fendo.2020.600439
Retrospective 219 COVID-19+ diabetes patients in the USA, showing lower mortality with existing metformin treatment.
risk of death, 60.8% lower, RR 0.39, p = 0.02, treatment 8 of 76 (10.5%), control 34 of 144 (23.6%), NNT 7.6, adjusted per study, odds ratio converted to relative risk, multiple logistic regression.
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Crouse et al., 13 Jan 2021, retrospective, USA, peer-reviewed, 6 authors.
Abstract: ORIGINAL RESEARCH
published: 13 January 2021
doi: 10.3389/fendo.2020.600439
Metformin Use Is Associated
With Reduced Mortality in
a Diverse Population With
COVID-19 and Diabetes
Andrew B. Crouse 1, Tiffany Grimes 2, Peng Li 3, Matthew Might 1, Fernando Ovalle 2
and Anath Shalev 2*
1
Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham, Birmingham, AL, United States,
Comprehensive Diabetes Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University
of Alabama at Birmingham, Birmingham, AL, United States, 3 School of Nursing, University of Alabama at Birmingham,
Birmingham, AL, United States
2
Edited by:
Hans Ulrich Häring,
Tübingen University Hospital,
Germany
Reviewed by:
Abdurezak Ahmed Abdela,
Addis Ababa University, Ethiopia
Mohd Ashraf Ganie,
Sher-I-Kashmir Institute
of Medical Sciences, India
*Correspondence:
Anath Shalev
shalev@uab.edu
Specialty section:
This article was submitted to
Clinical Diabetes,
a section of the journal
Frontiers in Endocrinology
Received: 30 August 2020
Accepted: 07 December 2020
Published: 13 January 2021
Citation:
Crouse AB, Grimes T, Li P, Might M,
Ovalle F and Shalev A (2021)
Metformin Use Is Associated
With Reduced Mortality in
a Diverse Population With
COVID-19 and Diabetes.
Front. Endocrinol. 11:600439.
doi: 10.3389/fendo.2020.600439
Background: Coronavirus disease-2019 (COVID-19) is a growing pandemic with an
increasing death toll that has been linked to various comorbidities as well as racial
disparity. However, the specific characteristics of these at-risk populations are still not
known and approaches to lower mortality are lacking.
Methods: We conducted a retrospective electronic health record data analysis of 25,326
subjects tested for COVID-19 between 2/25/20 and 6/22/20 at the University of Alabama
at Birmingham Hospital, a tertiary health care center in the racially diverse Southern U.S.
The primary outcome was mortality in COVID-19-positive subjects and the association
with subject characteristics and comorbidities was analyzed using simple and multiple
linear logistic regression.
Results: The odds ratio of contracting COVID-19 was disproportionately high in Blacks/
African-Americans (OR 2.6; 95% CI 2.19–3.10; p<0.0001) and in subjects with obesity
(OR 1.93; 95% CI 1.64–2.28; p<0.0001), hypertension (OR 2.46; 95% CI 2.07–2.93;
p<0.0001), and diabetes (OR 2.11; 95% CI 1.78–2.48; p<0.0001). Diabetes was also
associated with a dramatic increase in mortality (OR 3.62; 95% CI 2.11–6.2; p<0.0001)
and emerged as an independent risk factor in this diverse population even after correcting
for age, race, sex, obesity, and hypertension. Interestingly, we found that metformin
treatment prior to diagnosis of COVID-19 was independently associated with a significant
reduction in mortality in subjects with diabetes and COVID-19 (OR 0.33; 95% CI 0.13–
0.84; p=0.0210).
Conclusion: Thus, these results suggest that while diabetes is an independent risk factor
for COVID-19-related mortality, this risk is dramatically reduced in subjects taking
metformin prior to diagnosis of COVID-19, raising the possibility that metformin may
provide a protective approach in this high risk population.
Keywords: African-American, coronavirus disease-2019, diabetes, metformin, mortality
Frontiers in Endocrinology | www.frontiersin.org
1
January 2021 | Volume 11 | Article 600439
Crouse et al.
Metformin Reduced COVID-19 Mortality
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