Metformin use and mortality and length of stay among hospitalized patients with type 2 diabetes and COVID-19: A multiracial, multiethnic, urban observational study
Emily Miao, Kaleena Zhang, Jianyou Liu, Juan Lin, Donna Yoo, Claudene J George
Frontiers in Endocrinology, doi:10.3389/fendo.2022.1002834
Introduction: Diabetes mellitus is a common comorbidity among patients with coronavirus disease 2019 . Diabetic patients with COVID-19 have a two-fold increased risk of death and tend to have more severe infection compared to the general population. Metformin, a first-line medication for diabetes management, has anti-inflammatory and immunomodulatory effects. Previous studies focusing on metformin and COVID-19 clinical outcomes have had mixed results, with some showing a mortality benefit or decreased complications with metformin use. To date, few studies have analyzed such outcomes among a diverse, multiracial community. Methods: This was a retrospective review of patients with Type 2 diabetes and a confirmed COVID-19 infection admitted to an urban academic medical center from January 1, 2020 to May 7, 2020. Baseline characteristics were collected. The primary outcomes of the study were in-hospital mortality and length of stay (LOS). Results: A total of 4462 patients with Type 2 diabetes and confirmed COVID-19 were identified. 41.3% were Black, and 41.5% were Hispanic. There were 1021 patients in the metformin group and 3441 in the non-metformin group. Of note, more participants in the metformin group had comorbid disease and/or advanced diabetes. We found no statistically significant differences between the metformin and non-metformin group in in-hospital mortality (28.1% vs 25.3%, P=0.08) or length of hospital stay in days (7.3 vs. 7.5, P=0.59), even after matching patients on various factors (29.3% vs. 29.6%, P=0.87; 7.7 vs. 8.1, P=0.23).
Ethics statement The studies involving human participants were reviewed and approved by Albert Einstein College of Medicine, Montefiore Medical Center Institutional Review Board. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
Author contributions EM: Design, data management, interpretation of data, and preparation of manuscript; KZ: Design, data management, interpretation of data, and preparation of manuscript; JiL: Data management, analysis, interpretation of data, preparation of manuscript; JuL: Data management, analysis, interpretation of data, preparation of manuscript; DY: Interpretation of data, preparation of manuscript; CG: Design, acquisition of subjects, data management, analysis, interpretation of data, preparation of manuscript. All authors contributed to the article and approved the submitted version.
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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'abstract': '<jats:sec><jats:title>Introduction</jats:title><jats:p>Diabetes mellitus is a common '
'comorbidity among patients with coronavirus disease 2019 (COVID-19). Diabetic patients with '
'COVID-19 have a two-fold increased risk of death and tend to have more severe infection '
'compared to the general population. Metformin, a first-line medication for diabetes '
'management, has anti-inflammatory and immunomodulatory effects. Previous studies focusing on '
'metformin and COVID-19 clinical outcomes have had mixed results, with some showing a '
'mortality benefit or decreased complications with metformin use. To date, few studies have '
'analyzed such outcomes among a diverse, multiracial '
'community.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a '
'retrospective review of patients with Type 2 diabetes and a confirmed COVID-19 infection '
'admitted to an urban academic medical center from January 1, 2020 to May 7, 2020. Baseline '
'characteristics were collected. The primary outcomes of the study were in-hospital mortality '
'and length of stay '
'(LOS).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 4462 '
'patients with Type 2 diabetes and confirmed COVID-19 were identified. 41.3% were Black, and '
'41.5% were Hispanic. There were 1021 patients in the metformin group and 3441 in the '
'non-metformin group. Of note, more participants in the metformin group had comorbid disease '
'and/or advanced diabetes. We found no statistically significant differences between the '
'metformin and non-metformin group in in-hospital mortality (28.1% vs 25.3%, P=0.08) or length '
'of hospital stay in days (7.3 vs. 7.5, P=0.59), even after matching patients on various '
'factors (29.3% vs. 29.6%, P=0.87; 7.7 vs. 8.1, '
'P=0.23).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>While '
'patients had more comorbid disease and advanced diabetes in the metformin group, there were '
'no significant differences with regard to in-hospital mortality or length of stay due to '
'COVID-19 compared to the non-metformin group. Prospective studies are needed to determine if '
'there is clinical benefit for initiating, continuing, or re-initiating metformin in patients '
'hospitalized with COVID-19.</jats:p></jats:sec>',
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