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0 0.5 1 1.5 2+ Mortality 60% Improvement Relative Risk Ventilation 72% ICU admission 39% Oxygen therapy 30% Hospitalization -27% Metformin for COVID-19  Jang et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 556 patients in South Korea Lower mortality (p=0.018) and ventilation (p=0.008) Jang et al., Endocrinology and Metabol.., Jan 2024 Favors metformin Favors control

Impact of Antidiabetic Drugs on Clinical Outcomes of COVID-19: A Nationwide Population-Based Study

Jang et al., Endocrinology and Metabolism, doi:10.3803/EnM.2024.1857
Jan 2024  
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Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020
*, now known with p < 0.00000000001 from 84 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,900+ studies for 60+ treatments.
Retrospective 556 diabetic patients in South Korea with COVID-19 showing lower risk of mechanical ventilation and death with metformin, lower risks of oxygen treatment and death with DPP-4 inhibitors, and increased risk of mechanical ventilation with sulfonylureas. The study used nationwide data to analyze the impact of common antidiabetic medications on COVID-19 outcomes. Authors note that South Korea had a policy early in the pandemic of hospitalizing nearly all confirmed COVID-19 patients regardless of severity.
risk of death, 60.5% lower, OR 0.40, p = 0.02, treatment 461, control 95, adjusted per study, multivariable, RR approximated with OR.
risk of mechanical ventilation, 71.9% lower, OR 0.28, p = 0.008, treatment 461, control 95, adjusted per study, multivariable, RR approximated with OR.
risk of ICU admission, 38.8% lower, OR 0.61, p = 0.12, treatment 461, control 95, adjusted per study, multivariable, RR approximated with OR.
risk of oxygen therapy, 29.7% lower, OR 0.70, p = 0.23, treatment 461, control 95, adjusted per study, multivariable, RR approximated with OR.
risk of hospitalization, 27.1% higher, OR 1.27, p = 0.42, treatment 461, control 95, adjusted per study, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Jang et al., 29 Jan 2024, retrospective, South Korea, peer-reviewed, 6 authors. Contact:
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Impact of Antidiabetic Drugs on Clinical Outcomes of COVID-19: A Nationwide Population-Based Study
Han Na Jang, Sun Joon Moon, Jin Hyung Jung, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee
Endocrinology and Metabolism, doi:10.3803/enm.2024.1857
Background: Inconsistent results have been reported regarding the association between the use of antidiabetic drugs and the clinical outcomes of coronavirus disease 2019 . This study aimed to investigate the effect of antidiabetic drugs on COVID-19 outcomes in patients with diabetes using data from the National Health Insurance Service (NHIS) in South Korea. Methods: We analyzed the NHIS data of patients aged ≥20 years who tested positive for COVID-19 and were taking antidiabetic drugs between December 2019 and June 2020. Multiple logistic regression analysis was performed to analyze the clinical outcomes of COVID-19 based on the use of antidiabetic drugs. Results: A total of 556 patients taking antidiabetic drugs tested positive for COVID-19, including 271 male (48.7%), most of whom were in their sixties. Of all patients, 433 (77.9%) were hospitalized, 119 (21.4%) received oxygen treatment, 87 (15.6%) were admitted to the intensive care unit, 31 (5.6%) required mechanical ventilation, and 61 (11.0%) died. Metformin was significantly associated with the lower risks of mechanical ventilation (odds ratio [OR], 0.281; 95% confidence interval [CI], 0.109 to 0.720; P=0.008), and death (OR, 0.395; 95% CI, 0.182 to 0.854; P=0.018). Dipeptidylpeptidase-4 inhibitor (DPP-4i) were significantly associated with the lower risks of oxygen treatment (OR, 0.565; 95% CI, 0.356 to 0.895; P=0.015) and death (OR, 0.454; 95% CI, 0.217 to 0.949; P=0.036). Sulfonylurea was significantly associated with the higher risk of mechanical ventilation (OR, 2.579; 95% CI, 1.004 to 6.626; P=0.049). Conclusion: In patients with diabetes and COVID-19, metformin exhibited reduced risks of mechanical ventilation and death, DPP-4i was linked with lower risks of oxygen treatment and death, while sulfonylurea was related to the increased risk of mechanical ventilation.
AUTHOR CONTRIBUTIONS Conception or design: E.J.R., W.Y.L. Acquisition, analysis, or interpretation of data: S.J.M., J.H.J., K.D.H. Drafting the work or revising: H.N.J., S.J.M., E.J.R., W.Y.L. Final approval of the manuscript: H.N.J., S.J.M., J.H.J., K.D.H., E.J.R., W.Y.L.
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