Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes
Andrew B Crouse, Tiffany Grimes, Peng Li, Matthew Might, Fernando Ovalle, Anath Shalev
Frontiers in Endocrinology, 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.
ETHICS STATEMENT The studies involving human participants were reviewed and approved by UAB Institutional Review Board. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
AUTHOR CONTRIBUTIONS AC and TG were responsible for data acquisition and analysis. PL performed all the statistical analyses. MM and FO helped with the approach and interpretation. AS conceived the study and wrote the manuscript. All authors contributed to the article and approved the submitted version.
Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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'abstract': '<jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The odds '
'ratio of contracting COVID-19 was disproportionately high in Blacks/African-Americans (OR '
'2.6; 95% CI 2.19–3.10; p&lt;0.0001) and in subjects with obesity (OR 1.93; 95% CI '
'1.64–2.28; p&lt;0.0001), hypertension (OR 2.46; 95% CI 2.07–2.93; p&lt;0.0001), and '
'diabetes (OR 2.11; 95% CI 1.78–2.48; p&lt;0.0001). Diabetes was also associated with a '
'dramatic increase in mortality (OR 3.62; 95% CI 2.11–6.2; p&lt;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).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec>',
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