Infection Rates and Impact of Glucose Lowering Medications on the Clinical Course of COVID-19 in People with Type 2 Diabetes: A Retrospective Observational Study
Mannucci et al.,
Infection Rates and Impact of Glucose Lowering Medications on the Clinical Course of COVID-19 in People with..,
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, doi:10.2147/DMSO.S385646
Retrospective 54,009 diabetes patients in Italy, showing lower mortality with metformin use.
risk of death, 38.0% lower, OR 0.62, p = 0.02, RR approximated with OR.
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risk of hospitalization, 15.0% lower, OR 0.85, p = 0.25, RR approximated with OR.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Mannucci et al., 31 Oct 2022, retrospective, Italy, peer-reviewed, 10 authors, study period 1 March, 2020 - 31 December, 2020.
Contact:
gianpaolo.fadini@unipd.it.
Abstract: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
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ORIGINAL RESEARCH
Infection Rates and Impact of Glucose Lowering
Medications on the Clinical Course of COVID-19
in People with Type 2 Diabetes: A Retrospective
Observational Study
Francesca Mannucci 1 , Giacomo Vitturi 2 , Luca Benacchio 3 , Luca Gino Sbrogiò 4 , Francesca Bano 1 ,
Annunziata Lapolla 5 , Francesco Piarulli 5 , Maria Cecilia Giron 2 , Angelo Avogaro 6 ,
Gian Paolo Fadini 6
1
Pharmaceutical Unit, Local Health Unit 6, Padua, Italy; 2Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua,
Italy; 3Epidemiologic Unit, Local Health Unit 6, Padua, Italy; 4Prevention Department Local Health Unit 6, Padua, Italy; 5Diabetology Service, Local
Health Unit 6, Padua, Italy; 6Department of Medicine, University of Padova, Padua, Italy
Correspondence: Gian Paolo Fadini, Department of Medicine, University of Padova, Via Giustiniani 2, Padova, 35128, Italy, Tel +39 049 8214318,
Fax +39 049 8212184, Email gianpaolo.fadini@unipd.it
Purpose: Diabetes is a risk factor for COVID-19 severity, but the role played by glucose lowering medications (GLM) is still unclear.
The aim of this study was to assess infection rates and outcomes of COVID-19 (hospitalization and mortality) in adults with diabetes
assisted by the Local Health Unit of Padua (North-East Italy) according to the ongoing GLM.
Patients and Methods: People with diabetes were identified using administrative claims, while those with SARS-CoV-2 infection
were detected by cross referencing with the local COVID-19 surveillance registry. A multivariate logistic regression model was used to
verify the association between GLM classes and the outcome.
Results: SARS-CoV-2 infection rates were marginally but significantly higher in individuals with diabetes as compared to those
without diabetes (RR 1.04, p = 0.043), though such relative 4% increase may be irrelevant from a clinical and epidemiological
perspective. 1923 individuals with GLM-treated diabetes were diagnosed with COVID-19; 456 patients were hospitalized and 167
died. Those treated with insulin had a significantly higher risk of hospitalizations for COVID-19 (OR 1.48 p < 0.01) as were those
treated with sulphonylureas/glinides (OR 1.34, p = 0.02). Insulin use was also significantly associated with higher mortality (OR 1.90,
p < 0.01). Use of metformin was significantly associated with lower death rates (OR 0.62, p = 0.02). The association of other GLM
classes with the outcome was not significant.
Conclusion: Diabetes does not appear to modify the risk of SARS-CoV-2 infection in a clinically meaningful way, but strongly
increases the rates of hospitalization and death. Insulin use was associated with worse outcomes, whereas metformin use was
associated with lower mortality.
Keywords: diabetes mellitus, SARS-CoV-2, antidiabetic drugs, metformin, hospitalization, odds ratio, administrative claims, Veneto
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