Association of anti-diabetic drugs and covid-19 outcomes in patients with diabetes mellitus type 2 and chronic kidney disease: Nationwide registry analysis

{ 'indexed': {'date-parts': [[2024, 3, 28]], 'date-time': '2024-03-28T01:13:23Z', 'timestamp': 1711588403069}, 'reference-count': 57, 'publisher': 'Public Library of Science (PLoS)', 'issue': '3', 'license': [ { 'start': { 'date-parts': [[2024, 3, 27]], 'date-time': '2024-03-27T00:00:00Z', 'timestamp': 1711497600000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': ['www.plosone.org'], 'crossmark-restriction': False}, 'abstract': '<jats:sec id="sec001">\n' '<jats:title>Introduction</jats:title>\n' '<jats:p>Patients with diabetes mellitus type 2 and chronic kidney disease (T2DM-CKD) have a 5 ' 'times higher risk of developing severe SARS-CoV-2 infection than those without these 2 ' 'diseases. The goal of this study is to provide information on T2DM-CKD and COVID-19 outcomes, ' 'with an emphasis on the association with anti-diabetic medications.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec002">\n' '<jats:title>Methodology</jats:title>\n' '<jats:p>Study is designed as a retrospective cohort analysis covering the years 2020 and ' '2021. Data from the National Diabetes Registry (CroDiab) were linked to hospital data, ' 'primary healthcare data, Causes of Death Registry data, the SARS-CoV-2 vaccination database, ' 'and the SARS-CoV-2 test results database. Study outcomes were cumulative incidence of ' 'SARS-CoV-2 positivity, COVID-19 hospitalizations, and COVID-19 deaths. For outcome ' 'predictors, logistic regression models were developed.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec003">\n' '<jats:title>Results</jats:title>\n' '<jats:p>Of 231 796 patients with diabetes mellitus type 2 in the database, 7 539 were ' 'T2DM-CKD (3.25%). The 2-year cumulative incidences of all three studies’ outcomes were higher ' 'in T2DM-CKD than in diabetes patients without CKD (positivity 18.1% vs. 14.4%; ' 'hospitalization 9.7% vs. 4.2%; death 3.3% vs. 1.1%, all p&lt;0.001). For COVID-19 ' 'hospitalization, protective factors were SGLT-2 inhibitors use (OR 0.430; 95%CI 0.257–0.719) ' 'and metformin use (OR 0.769; 95% CI 0.643–0.920), risk factors were insulin use (1.411; 95%CI ' '1.167–1.706) and sulfonylureas use (OR 1.226; 95% CI 1.027–1.464). For SARS-CoV-2 positivity ' 'protective factors were SGLT-2 inhibitors (0.607; 95% CI 0.448–0.823), repaglinide use (OR ' '0.765; 95% CI 0.593–0.986) and metformin use (OR 0.857; 95% CI 0.770–0.994). DPP-4 inhibitors ' 'showed a non-significant decrease in risk for COVID-19 death (OR 0.761; 95% CI ' '0.568–1.019).</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec004">\n' '<jats:title>Conclusion</jats:title>\n' '<jats:p>T2DM-CKD are heavily burdened by COVID-19 disease. Our results suggest no association ' 'between antidiabetic drugs and COVID-19 death outcome while SGLT-2 and metformin show to be ' 'protective against COVID-19 hospitalization and infection, repaglinide against infection, and ' 'insulin and sulfonylureas show to be risk factors for COVID-19 hospitalization and infection. ' 'Further research in T2DM-CKD is needed.</jats:p>\n' '</jats:sec>', 'DOI': '10.1371/journal.pone.0301056', 'type': 'journal-article', 'created': {'date-parts': [[2024, 3, 27]], 'date-time': '2024-03-27T17:48:05Z', 'timestamp': 1711561685000}, 'page': 'e0301056', 'update-policy': 'http://dx.doi.org/10.1371/journal.pone.corrections_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Association of anti-diabetic drugs and covid-19 outcomes in patients with diabetes mellitus type ' '2 and chronic kidney disease: Nationwide registry analysis', 'prefix': '10.1371', 'volume': '19', 'author': [ { 'ORCID': 'http://orcid.org/0000-0003-3115-0186', 'authenticated-orcid': True, 'given': 'Jelena', 'family': 'Dimnjaković', 'sequence': 'first', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0003-1356-4166', 'authenticated-orcid': True, 'given': 'Tamara', 'family': 'Buble', 'sequence': 'additional', 'affiliation': []}, {'given': 'Pero', 'family': 'Ivanko', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0003-2336-0861', 'authenticated-orcid': True, 'given': 'Tamara', 'family': 'Poljičanin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sandra', 'family': 'Karanović Štambuk', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0003-0844-0054', 'authenticated-orcid': True, 'given': 'Hana', 'family': 'Brborović', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ognjen', 'family': 'Brborović', 'sequence': 'additional', 'affiliation': []}], 'member': '340', 'published-online': {'date-parts': [[2024, 3, 27]]}, 'reference': [ { 'issue': '2', 'key': 'pone.0301056.ref001', 'doi-asserted-by': 'crossref', 'first-page': '114', 'DOI': '10.37201/req/122.2022', 'article-title': 'Insights for COVID-19 in 2023.', 'volume': '36', 'author': 'FJ Martín Sánchez', 'year': '2023', 'journal-title': 'Rev Esp Quimioter.'}, { 'key': 'pone.0301056.ref002', 'article-title': 'With the international public health emergency ending, WHO/Europe ' 'launches its transition plan for COVID-19', 'author': 'World Health Organization', 'year': '2023'}, { 'issue': '10371', 'key': 'pone.0301056.ref003', 'doi-asserted-by': 'crossref', 'first-page': '79', 'DOI': '10.1016/S0140-6736(23)00050-8', 'article-title': 'The COVID-19 pandemic in 2023: far from over', 'volume': '401', 'author': 'The Lancet', 'year': '2023', 'journal-title': 'Lancet'}, { 'issue': '4', 'key': 'pone.0301056.ref004', 'doi-asserted-by': 'crossref', 'first-page': '723', 'DOI': '10.1177/1932296820930025', 'article-title': 'COVID-19: Considerations of Diabetes and Cardiovascular Disease ' 'Management.', 'volume': '14', 'author': 'A Ceriello', 'year': '2020', 'journal-title': 'J Diabetes Sci Technol'}, { 'issue': '1', 'key': 'pone.0301056.ref005', 'doi-asserted-by': 'crossref', 'first-page': '218', 'DOI': '10.1186/s12933-021-01408-1', 'article-title': 'Heart failure in type 2 diabetes: current perspectives on screening, ' 'diagnosis and management.', 'volume': '20', 'author': 'A Ceriello', 'year': '2021', 'journal-title': 'Cardiovasc Diabetol.'}, { 'issue': '2', 'key': 'pone.0301056.ref006', 'doi-asserted-by': 'crossref', 'first-page': '185', 'DOI': '10.23736/S0026-4806.21.07187-1', 'article-title': 'Role of comorbidities on the mortality in patients with SARS-CoV-2 ' 'infection: an Italian cohort study.', 'volume': '114', 'author': 'P Vergara', 'year': '2023', 'journal-title': 'Minerva Med.'}, { 'issue': '2', 'key': 'pone.0301056.ref007', 'doi-asserted-by': 'crossref', 'first-page': '313', 'DOI': '10.1007/s10238-022-00821-4', 'article-title': 'Comorbidities and clinical complications associated with SARS-CoV-2 ' 'infection: an overview.', 'volume': '23', 'author': 'A Gupta', 'year': '2023', 'journal-title': 'Clin Exp Med.'}, { 'issue': '1', 'key': 'pone.0301056.ref008', 'doi-asserted-by': 'crossref', 'first-page': '87', 'DOI': '10.1093/ndt/gfaa314', 'article-title': 'Chronic kidney disease is a key risk factor for severe COVID-19: a call ' 'to action by the ERA-EDTA.', 'volume': '36', 'author': 'European Renal Association–European Dialysis and Transplantation Association ' '(ERA-EDTA Council); 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