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0 0.5 1 1.5 2+ Mortality 78% Improvement Relative Risk Ventilation -27% Metformin for COVID-19  Li et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 131 patients in China (January - March 2020) Lower mortality with metformin (p=0.02) Li et al., Endocrine Practice, October 2020 Favors metformin Favors control

Metformin Use in Diabetes Prior to Hospitalization: Effects on Mortality in Covid-19

Li et al., Endocrine Practice, doi:10.4158/EP-2020-0466
Oct 2020  
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Retrospective 131 type II diabetes patients with COVID pneumonia, showing lower mortality with existing metformin use. Acarbose (commonly used in China as an initial therapy for diabetes) did not have a similar association with mortality, suggesting that the result may not be explained by metformin being used early in type II diabetes.
risk of death, 77.7% lower, HR 0.22, p = 0.02, treatment 2 of 37 (5.4%), control 21 of 94 (22.3%), NNT 5.9, adjusted per study, multivariable.
risk of mechanical ventilation, 27.0% higher, RR 1.27, p = 1.00, treatment 1 of 37 (2.7%), control 2 of 94 (2.1%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Li et al., 1 Oct 2020, retrospective, China, peer-reviewed, 16 authors, study period 23 January, 2020 - 19 March, 2020.
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Metformin Use in Diabetes Prior to Hospitalization: Effects on Mortality in Covid-19
MD Jinghong Li, MD Qi Wei, PhD Willis X Li, MD Karen C Mccowen, MD Wei Xiong, MD Jiao Liu, MD Wenlijun Jiang, PhD Traci Marin, MD Robert L Thomas, MD, PhD Ming He, PhD Brendan Gongol, MD Mark Hepokoski, Null- J Yuan, Null- J Shyy, MD Nian Xiong, MD Atul Malhotra
Endocrine Practice, doi:10.4158/ep-2020-0466
Objective: Although type 2 diabetes mellitus (T2DM) has been reported as a risk factor for coronavirus disease 2019 , the effect of pharmacologic agents used to treat T2DM, such as metformin, on COVID-19 outcomes remains unclear. Metformin increases the expression of angiotensin converting enzyme 2, a known receptor for severe acute respiratory syndrome coronavirus 2. Data from people with T2DM hospitalized for COVID-19 were used to test the hypothesis that metformin use is associated with improved survival in this population. Methods: Retrospective analyses were performed on de-identified clinical data from a major hospital in Wuhan, China, that included patients with T2DM hospitalized for COVID-19 during the recent epidemic. One hundred and thirty-one patients diagnosed with COVID-19 and T2DM were used in this study. The primary outcome was mortality. Demographic, clinical characteristics, laboratory data, diabetes medications, and respiratory therapy data were also included in the analysis. Results: Of these 131 patients, 37 used metformin with or without other antidiabetes medications. Among the 37 metformin-taking patients, 35 (94.6%) survived and 2 (5.4%) did not survive. The mortality rates in the metformin-taking group versus the non-metformin group were 5.4% (2/37) versus 22.3% (21/94). Using multivariate analysis, metformin was found to be an independent predictor of survival in this cohort (P = .02). Conclusion: This study reveals a significant association between metformin use and survival in people with T2DM diagnosed with COVID-19. These clinical data are consistent with potential benefits of the use of metformin for COVID-19 patients with T2DM.
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