The length of hospital stay in COVID-19 patients using pre-hospital metformin at a Saudi tertiary hospital: a retrospective cohort study

Felemban et al., BMC Infectious Diseases, doi:10.1186/s12879-026-13170-4, Mar 2026
Ventilation 44% improvement lower risk ← → higher risk ICU admission 9% ARDS 35% Discharge 46% Time to discharge 64% Metformin  Felemban et al.  PROPHYLAXIS Is prophylaxis with metformin beneficial for COVID-19? Retrospective 114 patients in Saudi Arabia Higher discharge with metformin (p=0.012) c19early.org Felemban et al., BMC Infectious Diseases, Mar 2026 0 0.5 1 1.5 2+ RR
Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020, now with p < 0.00000000001 from 111 studies.
No treatment is 100% effective. Protocols combine treatments.
6,500+ studies for 210+ treatments. c19early.org
Retrospective 114 hospitalized COVID-19 patients with T2DM in Saudi Arabia, showing significantly shorter hospital stay with pre-hospital metformin use.
risk of mechanical ventilation, 44.3% lower, RR 0.56, p = 0.24, treatment 10 of 82 (12.2%), control 7 of 32 (21.9%), NNT 10.
risk of ICU admission, 8.9% lower, RR 0.91, p = 0.79, treatment 14 of 82 (17.1%), control 6 of 32 (18.8%), NNT 60.
risk of ARDS, 35.0% lower, RR 0.65, p = 0.38, treatment 10 of 82 (12.2%), control 6 of 32 (18.8%), NNT 15.
risk of no hospital discharge, 45.9% lower, HR 0.54, p = 0.01, treatment 82, control 32, inverted to make HR<1 favor treatment.
time to discharge, 64.3% lower, relative time 0.36, p < 0.001, treatment 5.0 [4.0-6.0] n=82, control 14.0 [7.0-14.0] n=32.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Felemban et al., 31 Mar 2026, retrospective, Saudi Arabia, peer-reviewed, 8 authors. Contact: duaa.babaer@gmail.com.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org April 2026 Saudi Arabia Pakistan United Kingdom USA Russia Argentina Sudan Angola Colombia Kenya Mozambique Peru Philippines Spain Vietnam Brazil France Italy China Uzbekistan Iran Nepal Bangladesh Ethiopia Ghana Germany Mexico South Korea Algeria Morocco Yemen Poland Venezuela India DR Congo Madagascar Thailand Uganda Egypt Nigeria Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Iceland New Zealand Mongolia Belarus Hong Kong Qatar Panama Serbia CAR Saudi Arabia favored high-profit treatments.The average efficacy of treatments was moderate.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org April 2026 Saudi Arabia Pakistan United Kingdom USA Russia Argentina Sudan Angola Colombia Kenya Mozambique Peru Philippines Spain Vietnam Brazil France Japan China Uzbekistan Iran Nepal Bangladesh Ethiopia Ghana Germany Mexico South Korea Algeria Yemen Poland Venezuela India DR Congo Madagascar Thailand Uganda Egypt Nigeria Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia North Macedonia Hong Kong Qatar Panama Serbia CAR Saudi Arabia favored high-profit treatments.The average efficacy was moderate.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Abstract: 2. ACCEPTED MANUSCRIPT ARTICLE IN PRESS The Length of Hospital Stay in COVID-19 Patients Using Pre-hospital Metformin at a Saudi Tertiary Hospital: A Retrospective Cohort Study Authors and affiliations Razaz Felemban 1,2 , Talha S Mayet 1,2 , Zeyad O Khaimi 1,2 , Yazeed H Aljabri 1,2 , Mohammed A Hadi 1,2 , Abdulrahman F Alsulami 1,2 , Alaa Althubaiti 1,2 , Duaa Babaer 1,2 1. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia. King Abdullah International Medical Research Center, Jeddah, Saudi Arabia. Corresponding author Duaa Babaer Phone number: +966567034325 [Email: duaa.babaer@gmail.com](mailto:duaa.babaer@gmail.com) ARTIC/E IN PRESS Abstract Background Type 2 diabetes mellitus (T2DM) is prevalent in Saudi Arabia and is associated with severe outcomes from Coronavirus Disease 2019 (COVID-19). Metformin, the most prescribed medication for T2DM, has shown potential antiviral and anti-inflammatory properties that may be relevant in patients with COVID-19. This study evaluated the association of pre-hospital metformin use with length of hospital stay and secondary outcomes among patients with COVID-19 and T2DM. Methods ARTIC/E IN PRESS This retrospective cohort study was conducted at King Abdulaziz Medical City in Jeddah from 2020 to 2023 and included hospitalized adult patients with confirmed COVID-19 and pre-existing T2DM. Pre-hospital metformin use was defined as documented within 90 days before hospital admission. Clinical characteristics, treatments, and hospital outcomes were analyzed using electronic health record data. Results ACCEPTED MANUSCRIPT ARTICLE IN PRESS ACCEPTED MANUSCRIPT ARTICLE IN PRESS Metformin use was associated with a significantly shorter hospital stay, with a median time to discharge of five days (95% CI: 4-6) compared with 14 days (95% CI: 7-44) in the non-metformin group. Metformin use was associated with a higher hazard of discharge than nonuse (HR = 1.85, 95% CI: 1.14-3.0; p = 0.012). No statistically significant differences were observed between the two groups for secondary outcomes, including mechanical ventilation, intensive care unit admission, and respiratory complications, defined as acute respiratory distress syndrome and severe respiratory failure. Conclusion Among hospitalized patients with type 2 diabetes and COVID-19, metformin use was associated with shorter hospital stays and a higher discharge rate. However, given the retrospective, single-center design, potential survivor bias, and residual confounding, these findings should be interpreted cautiously. Prospective multicenter studies using competingrisk approaches and incorporating mortality outcomes are recommended. Keywords: COVID-19, Type 2 diabetes mellitus, Metformin, Hospital stay ARTIC/E IN PRESS ACCEPTED MANUSCRIPT ARTICLE IN PRESS ARTIC/E IN PRESS Background Coronavirus disease 2019 (COVID-19) is caused by the highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Although it primarily targets the respiratory system, it can also involve multiple extrapulmonary organs, including the renal and cardiovascular systems [1]. Consequently, the clinical manifestations and severity of COVID-19 are heterogeneous, reflecting the combined influence of viral factors and host-related risk profiles, with important implications for disease burden and outcomes at the..
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