Risk of Metformin in Patients With Type 2 Diabetes With COVID-19: A Preliminary Retrospective Report
Gao et al.,
Risk of Metformin in Patients With Type 2 Diabetes With COVID-19: A Preliminary Retrospective Report,
Clinical and Translational Science, doi:10.1111/cts.12897
Retrospective 110 hospitalized COVID-19 patients with diabetes in China, showing increased risk of severity with metformin.
risk of progression, 225.0% higher, RR 3.25, p = 0.045, treatment 16 of 56 (28.6%), control 4 of 54 (7.4%), odds ratio converted to relative risk, progression to life threatening complications.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Gao et al., 19 Oct 2020, retrospective, China, peer-reviewed, 7 authors, study period 31 January, 2020 - 20 March, 2020.
Abstract: Citation: Clin. Transl. Sci (2020) 13, 1055–1059;
doi:10.1111/cts.12897
BRIEF REPORT
Risk of Metformin in Patients With Type 2 Diabetes With
COVID-19: A Preliminary Retrospective Report
Yongchao Gao1,2,3,4, Tao Liu5, Weijun Zhong1,2,3,4, Rong Liu1,2,3,4, Honghao Zhou1,2,3,4, Weihua Huang1,2,3,4,* and Wei Zhang1,2,3,4,*
The current outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread across the
world. No specific antiviral agents have been adequately evidenced for the treatment of coronavirus disease 2019 (COVID19). Although metformin has been recommended as a host-directed therapy for COVID-19, there are some opposite views.
The effects of metformin on the disease severity of patients with COVID-19 with diabetes during hospitalization remains unclear. This study aimed to determine the effect of metformin on disease severity. We enrolled 110 hospitalized patients with
COVID-19 with diabetes prescribed either metformin or non-metformin hypoglycemic treatment for a case-control study. The
primary outcome was the occurrence of life-threatening complications. There were no differences between the two groups in
age, sex, comorbidities, and clinical severity at admission. Blood glucose and lactate dehydrogenase levels of the metformin
group were higher than those of the non-metformin group at admission. Other laboratory parameters at admission and treatments after admission were not different between the two groups. Strikingly, the percentage of patients who experienced
life-threatening complications was significantly higher in the metformin group (28.6% (16/56) vs. 7.4% (4/54), P = 0.004).
Antidiabetic therapy with metformin was associated with a higher risk of disease progression in patients with COVID-19
with diabetes during hospitalization (adjusted odds ratio = 3.964, 95% confidence interval 1.034–15.194, P = 0.045). This
retrospective analysis suggested a potential safety signal for metformin, the use of which was associated with a higher
risk of severe COVID-19. We propose that metformin withdrawal in patients with COVID-19 be considered to prevent disease
progression.
Study Highlights
WHAT IS THE CURRENT KNOWLEDGE ON THE
TOPIC?
✔ Diabetes is one of the most important comorbidities
of coronavirus disease 2019 (COVID-19) associated with
higher mortality. Metformin has been proposed to be a
candidate for host-directed treatment for COVID-19.
However, recent studies have argued that the risks of metformin in patients with COVID-19 and diabetes need to be
considered.
WHAT QUESTION DID THIS STUDY ADDRESS?
✔ We aimed to assess the association between metformin and life-threatening complications by conducting
a comparison on patients with COVID-19 with diabetes
between metformin users and nonusers.
WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?
✔ Among those patients with COVID-19 with diabetes,
more severe cases were found in metformin users than
in non-metformin cases (28.6% vs. 7.4%, P = 0.004).
Antidiabetic therapy with metformin was associated with
a higher risk of severe illness (adjusted odds ratio 3.964,
95% confidence interval 1.034–15.194).
HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?
✔ This study highlighted a potential safety signal for metformin, the use of which was associated with a higher risk
of severe COVID-19. Thus, we propose that metformin
withdrawal in patients with COVID-19 be considered to
prevent disease progression.
The current outbreak of..
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