Prior SGLT2 Inhibitor and Metformin Use and Risk of Long COVID in Type 2 Diabetes: A Nationwide Population-Based Cohort Study
et al., Infectious Diseases and Therapy, doi:10.1007/s40121-026-01362-z, Jun 2026
Metformin for COVID-19
3rd treatment shown to reduce risk in
July 2020, now with p < 0.00000000001 from 112 studies.
Lower risk for mortality, ventilation, ICU, hospitalization, progression, recovery, and viral clearance.
No treatment is 100% effective. Protocols
combine treatments.
6,600+ studies for
220+ treatments. c19early.org
|
Retrospective 71,698 patients with type 2 diabetes in Singapore showing reduced risk of long COVID with prior metformin use and SGLT2 inhibitor use.
|
risk of long COVID, 20.0% lower, HR 0.80, p = 0.01, treatment 42,906, control 2,307, adjusted per study, post-acute outcomes.
|
|
risk of long COVID, 23.0% lower, HR 0.77, p = 0.008, treatment 55,972, control 3,790, adjusted per study, post-acute symptoms.
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Ngiam et al., 3 Jun 2026, retrospective, Singapore, peer-reviewed, 15 authors, study period 1 July, 2021 - 28 February, 2023.
Contact: nicholas_ngiam@nuhs.edu.sg, russ_li@ncid.sg, matthew_koh@nuhs.edusg, kelvin_bryan_tan@moh.gov.sg, enoch_xh_loy@ncid.sge-mail, russ_li@ncid.sge-mail, kelvin_bryan_tan@moh.gov.sge-mail, ian.wee.l.e@singhealth.com.sg, enoch_xh_loy@ncid.sg, calvin_chiew@moh.gov.sg, david_lye@ncid.sg, chow_wai_leng@moh.gov.sg, lim.su.chi@ktph.com.sg, e_shyong_tai@nuhs.edu.sg, yew_woon_chia@ttsh.com.sg, mark_chan@nuhs.edu.sg, derek.hausenloy@nhcs.com.sg, bee.yong.mong@singhealth.com.sg.
Abstract: ## ORIGINAL RESEARCH
Prior SGLT2 Inhibitor and Metformin Use and Risk of Long COVID in Type 2 Diabetes: A Nationwide Population-Based Cohort Study
Jinghao Nicholas Ngiam · Enoch Xueheng Loy · Matthew Chung Yi Koh · Calvin J. Chiew · Russell Jingxian Li · Su Chi Lim · E Shyong Tai · Yong Mong Bee · Wai Leng Chow · David Chien Boon Lye · Yew Woon Chia · Mark Yan Yee Chan · Derek J. Hausenloy · Kelvin Bryan Tan · Liang En Wee
Received: April 6, 2026 / Accepted: May 4, 2026
© The Author(s) 2026
ABSTRACT
Introduction : Patients with type 2 diabetes mellitus (T2DM) are at increased risk of post-acute sequelae after COVID-19 (PASC). Sodium-glucose
Jinghao Nicholas Ngiam and Enoch Xueheng Loy contributed equally to this work.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s40121- 026- 01362-z.
- J. N. Ngiam ( * ) · M. C. Y. Koh Division of Infectious Diseases, Department of Medicine, National University Health System Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore e-mail: nicholas\_ngiam@nuhs.edu.sg
- M. C. Y. Koh e-mail: matthew\_koh@nuhs.edusg
- J. N. Ngiam · E. X. Loy · C. J. Chiew · R. J. Li · D. C. B. Lye · K. B. Tan · L. E. Wee Communicable Diseases Agency, Singapore, Singapore
e-mail: enoch\_xh\_loy@ncid.sge-mail: calvin\_chiew@ moh.gov.sge-mail: russ\_li@ncid.sge-mail: david\_lye@ ncid.sge-mail: kelvin\_bryan\_tan@moh.gov.sge-mail: ian.wee.l.e@singhealth.com.sg
- E. X. Loy · C. J. Chiew · R. J. Li · D. C. B. Lye · K. B. Tan · L. E. Wee National Centre for Infectious Diseases, Singapore, Singapore e-mail: enoch\_xh\_loy@ncid.sg
- C. J. Chiew e-mail: calvin\_chiew@moh.gov.sg
cotransporter-2 inhibitors (SGLT2i) and metformin may have systemic benefits beyond glycemic control. We evaluated the impact of prior SGLT2i and metformin use on the risk of post-acute COVID-19 complications.
Methods : We conducted a retrospective, population-based cohort study using national healthcare claims databases, from July 1, 2021 to February 28, 2023. Cohorts were stratified based on SGLT2i or metformin, against patients had not received these medications. Overlap weighting was applied to adjust for baseline differences in demographics, vaccination status,
- R. J. Li e-mail: russ\_li@ncid.sg
- D. C. B. Lye
3. e-mail: david\_lye@ncid.sg K. B. Tan e-mail: kelvin\_bryan\_tan@moh.gov.sg
- L. E. Wee e-mail: ian.wee.l.e@singhealth.com.sg
- C. J. Chiew · W. L. Chow · K. B. Tan Ministry of Health, Singapore, Singapore e-mail: chow\_wai\_leng@moh.gov.sg
- S. C. Lim · E. S. Tai · W. L. Chow · K. B. Tan Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore e-mail: lim.su.chi@ktph.com.sg
- E. S. Tai
8. e-mail: e\_shyong\_tai@nuhs.edu.sg S. C. Lim Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
Vol.:(0123456789)
comorbidities, and prior healthcare utilization. Competing-risks regression models were used to assess differences in the risk of long-COVID outcomes between 31 and 300 days post-infection. Results : Among 71,698 patients with T2DM, 22,501 (31.4%) had prior SGLT2i use, and 66,792 (93.1%) had prior metformin use. Compared with non-SGLT2i users, patients treated with SGLT2i had a significantly lower risk of neurological sequelae (aHR = 0.60 [0.45-0.81]), particularly memory and cognitive impairment (aHR = 0.63 [0.41-0.98]). SGLT2i was also associated with a..
DOI record:
{
"DOI": "10.1007/s40121-026-01362-z",
"ISSN": [
"2193-8229",
"2193-6382"
],
"URL": "http://dx.doi.org/10.1007/s40121-026-01362-z",
"alternative-id": [
"1362"
],
"assertion": [
{
"group": {
"label": "Article History",
"name": "ArticleHistory"
},
"label": "Received",
"name": "received",
"order": 1,
"value": "6 April 2026"
},
{
"group": {
"label": "Article History",
"name": "ArticleHistory"
},
"label": "Accepted",
"name": "accepted",
"order": 2,
"value": "4 May 2026"
},
{
"group": {
"label": "Article History",
"name": "ArticleHistory"
},
"label": "First Online",
"name": "first_online",
"order": 3,
"value": "3 June 2026"
},
{
"group": {
"label": "Declarations",
"name": "EthicsHeading"
},
"name": "Ethics",
"order": 1
},
{
"group": {
"label": "Conflict of Interest",
"name": "EthicsHeading"
},
"name": "Ethics",
"order": 2,
"value": "All authors [Jinghao Nicholas Ngiam, Enoch Xueheng Loy, Matthew Chung Yi Koh, Calvin J Chiew, Russell Jingxian Li, Su Chi Lim, E Shyong Tai, Yong Mong Bee, Wai Leng Chow, David Chien Boon Lye, Yew Woon Chia, Mark Yan Yee Chan, Derek J Hausenloy, Kelvin Bryan Tan, Liang En Wee] report no conflicts of interest."
},
{
"group": {
"label": "Ethical Approval",
"name": "EthicsHeading"
},
"name": "Ethics",
"order": 3,
"value": "This study was conducted as part of national public health surveillance under the Singapore Infectious Diseases Act, and separate ethics approval by an Institutional Review Board (IRB) was not required. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments."
}
],
"author": [
{
"ORCID": "https://orcid.org/0000-0002-3339-7281",
"affiliation": [],
"authenticated-orcid": false,
"family": "Ngiam",
"given": "Jinghao Nicholas",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "first"
},
{
"affiliation": [],
"family": "Loy",
"given": "Enoch Xueheng",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Koh",
"given": "Matthew Chung Yi",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Chiew",
"given": "Calvin J.",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Li",
"given": "Russell Jingxian",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Lim",
"given": "Su Chi",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Tai",
"given": "E Shyong",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Bee",
"given": "Yong Mong",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Chow",
"given": "Wai Leng",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Lye",
"given": "David Chien Boon",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Chia",
"given": "Yew Woon",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Chan",
"given": "Mark Yan Yee",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Hausenloy",
"given": "Derek J.",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Tan",
"given": "Kelvin Bryan",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
},
{
"affiliation": [],
"family": "Wee",
"given": "Liang En",
"role": [
{
"role": "author",
"vocabulary": "crossref"
}
],
"sequence": "additional"
}
],
"container-title": "Infectious Diseases and Therapy",
"container-title-short": "Infect Dis Ther",
"content-domain": {
"crossmark-restriction": false,
"domain": [
"link.springer.com"
]
},
"created": {
"date-parts": [
[
2026,
6,
3
]
],
"date-time": "2026-06-03T17:12:22Z",
"timestamp": 1780506742000
},
"deposited": {
"date-parts": [
[
2026,
6,
3
]
],
"date-time": "2026-06-03T17:12:23Z",
"timestamp": 1780506743000
},
"indexed": {
"date-parts": [
[
2026,
6,
3
]
],
"date-time": "2026-06-03T18:02:49Z",
"timestamp": 1780509769444,
"version": "3.54.1"
},
"is-referenced-by-count": 0,
"issued": {
"date-parts": [
[
2026,
6,
3
]
]
},
"language": "en",
"license": [
{
"URL": "https://creativecommons.org/licenses/by-nc/4.0",
"content-version": "tdm",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2026,
6,
3
]
],
"date-time": "2026-06-03T00:00:00Z",
"timestamp": 1780444800000
}
},
{
"URL": "https://creativecommons.org/licenses/by-nc/4.0",
"content-version": "vor",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2026,
6,
3
]
],
"date-time": "2026-06-03T00:00:00Z",
"timestamp": 1780444800000
}
}
],
"link": [
{
"URL": "https://link.springer.com/content/pdf/10.1007/s40121-026-01362-z.pdf",
"content-type": "application/pdf",
"content-version": "vor",
"intended-application": "text-mining"
},
{
"URL": "https://link.springer.com/article/10.1007/s40121-026-01362-z",
"content-type": "text/html",
"content-version": "vor",
"intended-application": "text-mining"
},
{
"URL": "https://link.springer.com/content/pdf/10.1007/s40121-026-01362-z.pdf",
"content-type": "application/pdf",
"content-version": "vor",
"intended-application": "similarity-checking"
}
],
"member": "297",
"original-title": [],
"prefix": "10.1007",
"published": {
"date-parts": [
[
2026,
6,
3
]
]
},
"published-online": {
"date-parts": [
[
2026,
6,
3
]
]
},
"publisher": "Springer Science and Business Media LLC",
"reference": [
{
"DOI": "10.1001/jama.2022.18931",
"author": "WS Hanson",
"doi-asserted-by": "publisher",
"first-page": "1604",
"issue": "16",
"journal-title": "JAMA",
"key": "1362_CR1",
"unstructured": "Global Burden of Disease Long COVID Collaborators, Hanson WS, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA. 2022;328(16):1604. https://doi.org/10.1001/jama.2022.18931.",
"volume": "328",
"year": "2022"
},
{
"DOI": "10.1093/cid/ciac961",
"author": "MM Robertson",
"doi-asserted-by": "publisher",
"first-page": "1636",
"issue": "9",
"journal-title": "Clin Infect Dis",
"key": "1362_CR2",
"unstructured": "Robertson MM, Qasmieh SA, Kulkarni SG, Teasdale CA, Jones HE, McNairy M, et al. The epidemiology of long coronavirus disease in US adults. Clin Infect Dis. 2023;76(9):1636–45. https://doi.org/10.1093/cid/ciac961.",
"volume": "76",
"year": "2023"
},
{
"DOI": "10.1093/infdis/jiaf030",
"author": "SM Bartsch",
"doi-asserted-by": "publisher",
"journal-title": "J Infect Dis",
"key": "1362_CR3",
"unstructured": "Bartsch SM, Chin KL, Strych U, John DC, Shah TD, Bottazzi ME, et al. The current and future burden of long COVID in the United States (U.S.). J Infect Dis. 2025. https://doi.org/10.1093/infdis/jiaf030.",
"year": "2025"
},
{
"DOI": "10.1016/j.diabres.2022.110202",
"author": "JL Harding",
"doi-asserted-by": "publisher",
"journal-title": "Diabetes Res Clin Pract",
"key": "1362_CR4",
"unstructured": "Harding JL, Oviedo SA, Ali MK, Ofotokun I, Gander JC, Patel SA, et al. The bidirectional association between diabetes and long-COVID-19—a systematic review. Diabetes Res Clin Pract. 2023;195:110202. https://doi.org/10.1016/j.diabres.2022.110202.",
"volume": "195",
"year": "2023"
},
{
"DOI": "10.1111/dme.14986",
"author": "BM Nørgård",
"doi-asserted-by": "publisher",
"issue": "2",
"journal-title": "Diabet Med",
"key": "1362_CR5",
"unstructured": "Nørgård BM, Zegers FD, Juhl CB, Kjeldsen J, Nielsen J. Diabetes mellitus and the risk of post‐acute COVID-19 hospitalizations—a nationwide cohort study. Diabet Med. 2023;40(2):e14986. https://doi.org/10.1111/dme.14986.",
"volume": "40",
"year": "2023"
},
{
"DOI": "10.1038/s41598-024-70437-z",
"author": "MC Nurchis",
"doi-asserted-by": "publisher",
"issue": "1",
"journal-title": "Sci Rep",
"key": "1362_CR6",
"unstructured": "Nurchis MC, Raspolini GM, Heidar Alizadeh A, Garlasco J, Elhadidy HSMA, Gianino MM, et al. An ecological comparison to inspect the aftermath of post COVID-19 condition in Italy and the United States. Sci Rep. 2024;14(1):19407. https://doi.org/10.1038/s41598-024-70437-z.",
"volume": "14",
"year": "2024"
},
{
"DOI": "10.1186/s12913-023-09601-6",
"author": "A Gandjour",
"doi-asserted-by": "publisher",
"issue": "1",
"journal-title": "BMC Health Serv Res",
"key": "1362_CR7",
"unstructured": "Gandjour A. Long COVID: costs for the German economy and health care and pension system. BMC Health Serv Res. 2023;23(1):641. https://doi.org/10.1186/s12913-023-09601-6.",
"volume": "23",
"year": "2023"
},
{
"DOI": "10.1161/CIR.0000000000000691",
"doi-asserted-by": "publisher",
"key": "1362_CR8",
"unstructured": "Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, et al. Type 2 diabetes mellitus and heart failure: a scientific statement from the American Heart Association and the Heart Failure Society of America: this statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation. 2019. https://doi.org/10.1161/CIR.0000000000000691."
},
{
"DOI": "10.1111/dom.13854",
"author": "RJ Chilton",
"doi-asserted-by": "publisher",
"first-page": "16",
"issue": "1",
"journal-title": "Diabetes Obes Metab",
"key": "1362_CR9",
"unstructured": "Chilton RJ. Effects of sodium‐glucose cotransporter‐2 inhibitors on the cardiovascular and renal complications of type 2 diabetes. Diabetes Obes Metab. 2020;22(1):16–29. https://doi.org/10.1111/dom.13854.",
"volume": "22",
"year": "2020"
},
{
"DOI": "10.1136/gutjnl-2024-332481",
"author": "X Mao",
"doi-asserted-by": "publisher",
"first-page": "2054",
"issue": "12",
"journal-title": "Gut",
"key": "1362_CR10",
"unstructured": "Mao X, Zhang X, Kam L, Chien N, Lai R, Cheung KS, et al. Synergistic association of sodium-glucose cotransporter-2 inhibitor and metformin on liver and non-liver complications in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease. Gut. 2024;73(12):2054–61. https://doi.org/10.1136/gutjnl-2024-332481.",
"volume": "73",
"year": "2024"
},
{
"DOI": "10.1038/s41598-019-49525-y",
"author": "JH Bae",
"doi-asserted-by": "publisher",
"issue": "1",
"journal-title": "Sci Rep",
"key": "1362_CR11",
"unstructured": "Bae JH, Park EG, Kim S, Kim SG, Hahn S, Kim NH. Effects of sodium-glucose cotransporter 2 inhibitors on renal outcomes in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2019;9(1):13009. https://doi.org/10.1038/s41598-019-49525-y.",
"volume": "9",
"year": "2019"
},
{
"DOI": "10.1002/jcp.30621",
"author": "S Ravindran",
"doi-asserted-by": "publisher",
"first-page": "1182",
"issue": "2",
"journal-title": "J Cell Physiol",
"key": "1362_CR12",
"unstructured": "Ravindran S, Munusamy S. Renoprotective mechanisms of sodium‐glucose co‐transporter 2 (SGLT2) inhibitors against the progression of diabetic kidney disease. J Cell Physiol. 2022;237(2):1182–205. https://doi.org/10.1002/jcp.30621.",
"volume": "237",
"year": "2022"
},
{
"DOI": "10.1080/03007995.2022.2027141",
"author": "A Alshnbari",
"doi-asserted-by": "publisher",
"first-page": "357",
"issue": "3",
"journal-title": "Curr Med Res Opin",
"key": "1362_CR13",
"unstructured": "Alshnbari A, Idris I. Can sodium-glucose co-transporter-2 (SGLT-2) inhibitor reduce the risk of adverse complications due to COVID-19?—targeting hyperinflammation. Curr Med Res Opin. 2022;38(3):357–64. https://doi.org/10.1080/03007995.2022.2027141.",
"volume": "38",
"year": "2022"
},
{
"DOI": "10.3390/jcm9072030",
"author": "B Fernandez-Fernandez",
"doi-asserted-by": "publisher",
"issue": "7",
"journal-title": "JCM",
"key": "1362_CR14",
"unstructured": "Fernandez-Fernandez B, D’Marco L, Górriz JL, Jacobs-Cachá C, Kanbay M, Luis-Lima S, et al. Exploring sodium glucose co-transporter-2 (SGLT2) inhibitors for organ protection in COVID-19. JCM. 2020;9(7):2030. https://doi.org/10.3390/jcm9072030.",
"volume": "9",
"year": "2020"
},
{
"DOI": "10.1002/iub.2719",
"author": "H Yaribeygi",
"doi-asserted-by": "publisher",
"first-page": "648",
"issue": "8",
"journal-title": "IUBMB Life",
"key": "1362_CR15",
"unstructured": "Yaribeygi H, Maleki M, Atkin SL, Kesharwani P, Jamialahmadi T, Sahebkar A. Anti‐inflammatory effects of sodium‐glucose cotransporter‐2 inhibitors in COVID‐19. IUBMB Life. 2023;75(8):648–58. https://doi.org/10.1002/iub.2719.",
"volume": "75",
"year": "2023"
},
{
"DOI": "10.3389/fimmu.2020.02056",
"author": "X Chen",
"doi-asserted-by": "publisher",
"journal-title": "Front Immunol",
"key": "1362_CR16",
"unstructured": "Chen X, Guo H, Qiu L, Zhang C, Deng Q, Leng Q. Immunomodulatory and antiviral activity of metformin and its potential implications in treating coronavirus disease 2019 and lung injury. Front Immunol. 2020;11:2056. https://doi.org/10.3389/fimmu.2020.02056.",
"volume": "11",
"year": "2020"
},
{
"DOI": "10.1016/j.immuni.2021.05.004",
"author": "H Xian",
"doi-asserted-by": "publisher",
"first-page": "1463",
"issue": "7",
"journal-title": "Immunity",
"key": "1362_CR17",
"unstructured": "Xian H, Liu Y, Rundberg Nilsson A, Gatchalian R, Crother TR, Tourtellotte WG, et al. Metformin inhibition of mitochondrial ATP and DNA synthesis abrogates NLRP3 inflammasome activation and pulmonary inflammation. Immunity. 2021;54(7):1463-1477.e11. https://doi.org/10.1016/j.immuni.2021.05.004.",
"volume": "54",
"year": "2021"
},
{
"DOI": "10.3389/fimmu.2021.733921",
"author": "TJ Cory",
"doi-asserted-by": "publisher",
"journal-title": "Front Immunol",
"key": "1362_CR18",
"unstructured": "Cory TJ, Emmons RS, Yarbro JR, Davis KL, Pence BD. Metformin suppresses monocyte immunometabolic activation by SARS-CoV-2 spike protein subunit 1. Front Immunol. 2021;12:733921. https://doi.org/10.3389/fimmu.2021.733921.",
"volume": "12",
"year": "2021"
},
{
"DOI": "10.1371/journal.ppat.1009634",
"author": "E Varghese",
"doi-asserted-by": "publisher",
"issue": "6",
"journal-title": "PLoS Pathog",
"key": "1362_CR19",
"unstructured": "Varghese E, Samuel SM, Liskova A, Kubatka P, Büsselberg D. Diabetes and coronavirus (SARS-CoV-2): molecular mechanism of metformin intervention and the scientific basis of drug repurposing. PLoS Pathog. 2021;17(6):e1009634. https://doi.org/10.1371/journal.ppat.1009634.",
"volume": "17",
"year": "2021"
},
{
"DOI": "10.3390/v16121938",
"author": "I Halabitska",
"doi-asserted-by": "publisher",
"issue": "12",
"journal-title": "Viruses",
"key": "1362_CR20",
"unstructured": "Halabitska I, Petakh P, Lushchak O, Kamyshna I, Oksenych V, Kamyshnyi O. Metformin in antiviral therapy: evidence and perspectives. Viruses. 2024;16(12):1938. https://doi.org/10.3390/v16121938.",
"volume": "16",
"year": "2024"
},
{
"DOI": "10.1016/S1473-3099(23)00299-2",
"author": "CT Bramante",
"doi-asserted-by": "publisher",
"first-page": "1119",
"issue": "10",
"journal-title": "Lancet Infect Dis",
"key": "1362_CR21",
"unstructured": "Bramante CT, Buse JB, Liebovitz DM, Nicklas JM, Puskarich MA, Cohen K, et al. Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial. Lancet Infect Dis. 2023;23(10):1119–29. https://doi.org/10.1016/S1473-3099(23)00299-2.",
"volume": "23",
"year": "2023"
},
{
"DOI": "10.3390/jcm13020431",
"author": "KR Lim",
"doi-asserted-by": "publisher",
"issue": "2",
"journal-title": "JCM",
"key": "1362_CR22",
"unstructured": "Lim KR, Chun KJ, Kim BS, Lee S. The effect of sodium–glucose cotransporter-2 inhibitors on COVID-19 patients with type 2 diabetes mellitus: a retrospective cohort study using the common data model. JCM. 2024;13(2):431. https://doi.org/10.3390/jcm13020431.",
"volume": "13",
"year": "2024"
},
{
"DOI": "10.2337/dca24-0032",
"author": "SG Johnson",
"doi-asserted-by": "publisher",
"first-page": "1930",
"issue": "11",
"journal-title": "Diabetes Care",
"key": "1362_CR23",
"unstructured": "Johnson SG, Abedian S, Stürmer T, Huling JD, Lewis VC, Buse JB, et al. Prevalent metformin use in adults with diabetes and the incidence of long COVID: an EHR-based cohort study from the RECOVER program. Diabetes Care. 2024;47(11):1930–40. https://doi.org/10.2337/dca24-0032.",
"volume": "47",
"year": "2024"
},
{
"DOI": "10.1186/s12985-025-03054-5",
"author": "HW Yeh",
"doi-asserted-by": "publisher",
"issue": "1",
"journal-title": "Virol J",
"key": "1362_CR24",
"unstructured": "Yeh HW, Chaou CH, Yang SF, Wang YH, Kuan YH, Yeh CB. SGLT2 inhibitors prevent long-COVID-associated cognitive and pain symptoms in type 2 diabetes patients. Virol J. 2025;23(1):27. https://doi.org/10.1186/s12985-025-03054-5.",
"volume": "23",
"year": "2025"
},
{
"DOI": "10.1093/cid/ciaf429",
"author": "U Chaichana",
"doi-asserted-by": "publisher",
"first-page": "e423",
"issue": "3",
"journal-title": "Clin Infect Dis",
"key": "1362_CR25",
"unstructured": "Chaichana U, Man KKC, Ju C, Makaronidis J, Wei L. Effect of metformin on the risk of Post-COVID-19 condition among individuals with overweight or obese: a population-based retrospective cohort study. Clin Infect Dis. 2026;82(3):e423–32. https://doi.org/10.1093/cid/ciaf429.",
"volume": "82",
"year": "2026"
},
{
"DOI": "10.1016/j.cmi.2023.06.016",
"author": "LE Wee",
"doi-asserted-by": "publisher",
"first-page": "1328",
"issue": "10",
"journal-title": "Clin Microbiol Infect",
"key": "1362_CR26",
"unstructured": "Wee LE, Tay AT, Chiew C, Young BE, Wong B, Lim R, et al. Real-world effectiveness of nirmatrelvir/ritonavir against COVID-19 hospitalizations and severe COVID-19 in community-dwelling elderly Singaporeans during Omicron BA.2, BA.4/5, and XBB transmission. Clin Microbiol Infect. 2023;29(10):1328–33. https://doi.org/10.1016/j.cmi.2023.06.016.",
"volume": "29",
"year": "2023"
},
{
"DOI": "10.1001/jamanetworkopen.2024.30983",
"author": "LE Wee",
"doi-asserted-by": "publisher",
"issue": "8",
"journal-title": "JAMA Netw Open",
"key": "1362_CR27",
"unstructured": "Wee LE, Lim JT, Tay AT, Chiew CJ, Ong B, Lye DCB, et al. Autoimmune sequelae after Delta or Omicron variant SARS-CoV-2 infection in a highly vaccinated cohort. JAMA Netw Open. 2024;7(8):e2430983. https://doi.org/10.1001/jamanetworkopen.2024.30983.",
"volume": "7",
"year": "2024"
},
{
"DOI": "10.1093/cid/ciad469",
"author": "JT Lim",
"doi-asserted-by": "publisher",
"first-page": "70",
"issue": "1",
"journal-title": "Clin Infect Dis",
"key": "1362_CR28",
"unstructured": "Lim JT, Liang En W, Tay AT, Pang D, Chiew CJ, Ong B, et al. Long-term cardiovascular, cerebrovascular, and other thrombotic complications in COVID-19 survivors: a retrospective cohort study. Clin Infect Dis. 2024;78(1):70–9. https://doi.org/10.1093/cid/ciad469.",
"volume": "78",
"year": "2024"
},
{
"DOI": "10.1016/j.cmi.2023.12.019",
"author": "LE Wee",
"doi-asserted-by": "publisher",
"first-page": "531",
"issue": "4",
"journal-title": "Clin Microbiol Infect",
"key": "1362_CR29",
"unstructured": "Wee LE, Lim JT, Tay AT, Pang D, Dickens B, Chiew CJ, et al. Long-term neuropsychiatric sequelae of Delta versus Omicron SARS-CoV-2 infection. Clin Microbiol Infect. 2024;30(4):531–9. https://doi.org/10.1016/j.cmi.2023.12.019.",
"volume": "30",
"year": "2024"
},
{
"DOI": "10.1016/j.cmi.2024.08.019",
"author": "LE Wee",
"doi-asserted-by": "publisher",
"journal-title": "Clin Microbiol Infect",
"key": "1362_CR30",
"unstructured": "Wee LE, Lim JT, Tay AT, Chiew CJ, Young BE, Wong B, et al. Nirmatrelvir/ritonavir treatment and risk for postacute sequelae of COVID-19 in older Singaporeans. Clin Microbiol Infect. 2024. https://doi.org/10.1016/j.cmi.2024.08.019.",
"year": "2024"
},
{
"DOI": "10.1016/S0140-673(21)00252-X",
"author": "CC Tan",
"doi-asserted-by": "publisher",
"first-page": "1091",
"issue": "10305",
"journal-title": "Lancet",
"key": "1362_CR31",
"unstructured": "Tan CC, Lam CSP, Matchar DB, Zee YK, Wong JEL. Singapore’s health-care system: key features, challenges, and shifts. Lancet. 2021;398(10305):1091–104. https://doi.org/10.1016/S0140-673(21)00252-X.",
"volume": "398",
"year": "2021"
},
{
"DOI": "10.3390/ijms24010755",
"author": "I Nojima",
"doi-asserted-by": "publisher",
"issue": "1",
"journal-title": "Int J Mol Sci",
"key": "1362_CR32",
"unstructured": "Nojima I, Wada J. Metformin and its immune-mediated effects in various diseases. Int J Mol Sci. 2023;24(1):755. https://doi.org/10.3390/ijms24010755.",
"volume": "24",
"year": "2023"
},
{
"DOI": "10.1016/j.tim.2021.03.004",
"author": "SM Samuel",
"doi-asserted-by": "publisher",
"first-page": "894",
"issue": "10",
"journal-title": "Trends Microbiol",
"key": "1362_CR33",
"unstructured": "Samuel SM, Varghese E, Büsselberg D. Therapeutic potential of metformin in COVID-19: reasoning for its protective role. Trends Microbiol. 2021;29(10):894–907. https://doi.org/10.1016/j.tim.2021.03.004.",
"volume": "29",
"year": "2021"
},
{
"DOI": "10.3389/fendo.2021.645194",
"author": "M Zangiabadian",
"doi-asserted-by": "publisher",
"journal-title": "Front Endocrinol",
"key": "1362_CR34",
"unstructured": "Zangiabadian M, Nejadghaderi SA, Zahmatkesh MM, Hajikhani B, Mirsaeidi M, Nasiri MJ. The efficacy and potential mechanisms of metformin in the treatment of COVID-19 in the diabetics: a systematic review. Front Endocrinol. 2021;12:645194. https://doi.org/10.3389/fendo.2021.645194.",
"volume": "12",
"year": "2021"
},
{
"DOI": "10.3390/ijms25105190",
"author": "TJ Plowman",
"doi-asserted-by": "publisher",
"issue": "10",
"journal-title": "Int J Mol Sci",
"key": "1362_CR35",
"unstructured": "Plowman TJ, Christensen H, Aiges M, Fernandez E, Shah MH, Ramana KV. Anti-inflammatory potential of the anti-diabetic drug metformin in the prevention of inflammatory complications and infectious diseases including COVID-19: a narrative review. Int J Mol Sci. 2024;25(10):5190. https://doi.org/10.3390/ijms25105190.",
"volume": "25",
"year": "2024"
},
{
"DOI": "10.1016/j.virusres.2022.199010",
"author": "H Parthasarathy",
"doi-asserted-by": "publisher",
"journal-title": "Virus Res",
"key": "1362_CR36",
"unstructured": "Parthasarathy H, Tandel D, Siddiqui AH, Harshan KH. Metformin suppresses SARS-CoV-2 in cell culture. Virus Res. 2023;323:199010. https://doi.org/10.1016/j.virusres.2022.199010.",
"volume": "323",
"year": "2023"
},
{
"DOI": "10.1093/cid/ciae159",
"author": "CT Bramante",
"doi-asserted-by": "publisher",
"first-page": "354",
"issue": "2",
"journal-title": "Clin Infect Dis",
"key": "1362_CR37",
"unstructured": "Bramante CT, Beckman KB, Mehta T, Karger AB, Odde DJ, Tignanelli CJ, et al. Favorable antiviral effect of metformin on SARS-CoV-2 viral load in a randomized, placebo-controlled clinical trial of COVID-19. Clin Infect Dis. 2024;79(2):354–63. https://doi.org/10.1093/cid/ciae159.",
"volume": "79",
"year": "2024"
},
{
"DOI": "10.3390/v16020281",
"author": "P Petakh",
"doi-asserted-by": "publisher",
"issue": "2",
"journal-title": "Viruses",
"key": "1362_CR38",
"unstructured": "Petakh P, Kamyshna I, Oksenych V, Kamyshnyi O. Metformin alters mRNA expression of FOXP3, RORC, and TBX21 and modulates gut microbiota in COVID-19 patients with Type 2 diabetes. Viruses. 2024;16(2):281. https://doi.org/10.3390/v16020281.",
"volume": "16",
"year": "2024"
},
{
"DOI": "10.2174/0109298673289342240213040144",
"author": "P Shivaprakash",
"doi-asserted-by": "publisher",
"first-page": "31",
"journal-title": "CMC",
"key": "1362_CR39",
"unstructured": "Shivaprakash P, Beeraka NM, Madhunapantula SRV, Nikolenko VN, Basalingappa KM. Metformin effects on SHIP2, AMPKs and gut microbiota: recent updates on pharmacology. CMC. 2024;21:31. https://doi.org/10.2174/0109298673289342240213040144.",
"volume": "21",
"year": "2024"
},
{
"DOI": "10.1001/jamanetworkopen.2022.44652",
"author": "Z Zhu",
"doi-asserted-by": "publisher",
"issue": "12",
"journal-title": "JAMA Netw Open",
"key": "1362_CR40",
"unstructured": "Zhu Z, Zeng Q, Liu Q, Wen J, Chen G. Association of glucose-lowering drugs with outcomes in patients with diabetes before hospitalization for COVID-19: a systematic review and network meta-analysis. JAMA Netw Open. 2022;5(12):e2244652. https://doi.org/10.1001/jamanetworkopen.2022.44652.",
"volume": "5",
"year": "2022"
},
{
"DOI": "10.1016/j.diabres.2022.110205",
"author": "H Permana",
"doi-asserted-by": "publisher",
"journal-title": "Diabetes Res Clin Pract",
"key": "1362_CR41",
"unstructured": "Permana H, Audi Yanto T, Ivan Hariyanto T. Pre-admission use of sodium glucose transporter-2 inhibitor (SGLT-2i) may significantly improves Covid-19 outcomes in patients with diabetes: a systematic review, meta-analysis, and meta-regression. Diabetes Res Clin Pract. 2023;195:110205. https://doi.org/10.1016/j.diabres.2022.110205.",
"volume": "195",
"year": "2023"
},
{
"DOI": "10.1016/j.tem.2024.02.003",
"author": "M Mashayekhi",
"doi-asserted-by": "publisher",
"first-page": "425",
"issue": "5",
"journal-title": "Trends Endocrinol Metab",
"key": "1362_CR42",
"unstructured": "Mashayekhi M, Safa BI, Gonzalez MSC, Kim SF, Echouffo-Tcheugui JB. Systemic and organ-specific anti-inflammatory effects of sodium-glucose cotransporter-2 inhibitors. Trends Endocrinol Metab. 2024;35(5):425–38. https://doi.org/10.1016/j.tem.2024.02.003.",
"volume": "35",
"year": "2024"
},
{
"DOI": "10.3390/ijms23105634",
"author": "S Feijóo-Bandín",
"doi-asserted-by": "publisher",
"issue": "10",
"journal-title": "IJMS",
"key": "1362_CR43",
"unstructured": "Feijóo-Bandín S, Aragón-Herrera A, Otero-Santiago M, Anido-Varela L, Moraña-Fernández S, Tarazón E, et al. Role of sodium-glucose co-transporter 2 inhibitors in the regulation of inflammatory processes in animal models. IJMS. 2022;23(10):5634. https://doi.org/10.3390/ijms23105634.",
"volume": "23",
"year": "2022"
},
{
"DOI": "10.3390/ijerph20176671",
"author": "E Schönberger",
"doi-asserted-by": "publisher",
"issue": "17",
"journal-title": "IJERPH",
"key": "1362_CR44",
"unstructured": "Schönberger E, Mihaljević V, Steiner K, Šarić S, Kurevija T, Majnarić LT, et al. Immunomodulatory effects of SGLT2 inhibitors—targeting inflammation and oxidative stress in aging. IJERPH. 2023;20(17):6671. https://doi.org/10.3390/ijerph20176671.",
"volume": "20",
"year": "2023"
},
{
"DOI": "10.1111/dom.13577",
"author": "JH Kim",
"doi-asserted-by": "publisher",
"first-page": "801",
"issue": "4",
"journal-title": "Diabetes Obes Metab",
"key": "1362_CR45",
"unstructured": "Kim JH, Lee M, Kim SH, Kim SR, Lee B, Kang ES, et al. Sodium‐glucose cotransporter 2 inhibitors regulate ketone body metabolism via inter‐organ crosstalk. Diabetes Obes Metab. 2019;21(4):801–11. https://doi.org/10.1111/dom.13577.",
"volume": "21",
"year": "2019"
},
{
"DOI": "10.1002/jcb.30327",
"author": "H Yaribeygi",
"doi-asserted-by": "publisher",
"first-page": "1879",
"issue": "12",
"journal-title": "J Cell Biochem",
"key": "1362_CR46",
"unstructured": "Yaribeygi H, Maleki M, Butler AE, Jamialahmadi T, Sahebkar A. New insights into cellular links between sodium–glucose cotransporter‐2 inhibitors and ketogenesis. J Cell Biochem. 2022;123(12):1879–90. https://doi.org/10.1002/jcb.30327.",
"volume": "123",
"year": "2022"
},
{
"DOI": "10.3390/ijms24076039",
"author": "ME Youssef",
"doi-asserted-by": "publisher",
"issue": "7",
"journal-title": "Int J Mol Sci",
"key": "1362_CR47",
"unstructured": "Youssef ME, Yahya G, Popoviciu MS, Cavalu S, Abd-Eldayem MA, Saber S. Unlocking the full potential of SGLT2 inhibitors: expanding applications beyond glycemic control. Int J Mol Sci. 2023;24(7):6039. https://doi.org/10.3390/ijms24076039.",
"volume": "24",
"year": "2023"
},
{
"DOI": "10.1210/endocr/bqab157",
"author": "M Ala",
"doi-asserted-by": "publisher",
"issue": "12",
"journal-title": "Endocrinology",
"key": "1362_CR48",
"unstructured": "Ala M. SGLT2 inhibition for cardiovascular diseases, chronic kidney disease, and NAFLD. Endocrinology. 2021;162(12):bqab157. https://doi.org/10.1210/endocr/bqab157.",
"volume": "162",
"year": "2021"
},
{
"DOI": "10.3390/molecules26237213",
"author": "A Pawlos",
"doi-asserted-by": "publisher",
"issue": "23",
"journal-title": "Molecules",
"key": "1362_CR49",
"unstructured": "Pawlos A, Broncel M, Woźniak E, Gorzelak-Pabiś P. Neuroprotective effect of SGLT2 inhibitors. Molecules. 2021;26(23):7213. https://doi.org/10.3390/molecules26237213.",
"volume": "26",
"year": "2021"
},
{
"DOI": "10.1016/j.jacc.2019.11.031",
"author": "TA Zelniker",
"doi-asserted-by": "publisher",
"first-page": "422",
"issue": "4",
"journal-title": "J Am Coll Cardiol",
"key": "1362_CR50",
"unstructured": "Zelniker TA, Braunwald E. Mechanisms of cardiorenal effects of sodium-glucose cotransporter 2 inhibitors. J Am Coll Cardiol. 2020;75(4):422–34. https://doi.org/10.1016/j.jacc.2019.11.031.",
"volume": "75",
"year": "2020"
},
{
"DOI": "10.1007/s11096-021-01256-9",
"author": "T Koufakis",
"doi-asserted-by": "publisher",
"first-page": "764",
"issue": "3",
"journal-title": "Int J Clin Pharm",
"key": "1362_CR51",
"unstructured": "Koufakis T, Pavlidis AN, Metallidis S, Kotsa K. Sodium-glucose co-transporter 2 inhibitors in COVID-19: meeting at the crossroads between heart, diabetes and infectious diseases. Int J Clin Pharm. 2021;43(3):764–7. https://doi.org/10.1007/s11096-021-01256-9.",
"volume": "43",
"year": "2021"
},
{
"DOI": "10.1038/s41591-024-02987-8",
"author": "M Cai",
"doi-asserted-by": "publisher",
"first-page": "1564",
"issue": "6",
"journal-title": "Nat Med",
"key": "1362_CR52",
"unstructured": "Cai M, Xie Y, Topol EJ, Al-Aly Z. Three-year outcomes of post-acute sequelae of COVID-19. Nat Med. 2024;30(6):1564–73. https://doi.org/10.1038/s41591-024-02987-8.",
"volume": "30",
"year": "2024"
},
{
"DOI": "10.1038/s41591-023-02521-2",
"author": "B Bowe",
"doi-asserted-by": "publisher",
"first-page": "2347",
"issue": "9",
"journal-title": "Nat Med",
"key": "1362_CR53",
"unstructured": "Bowe B, Xie Y, Al-Aly Z. Postacute sequelae of COVID-19 at 2 years. Nat Med. 2023;29(9):2347–57. https://doi.org/10.1038/s41591-023-02521-2.",
"volume": "29",
"year": "2023"
},
{
"DOI": "10.1097/MD.0000000000007201",
"author": "J Li",
"doi-asserted-by": "publisher",
"issue": "27",
"journal-title": "Medicine",
"key": "1362_CR54",
"unstructured": "Li J, Gong Y, Li C, Lu Y, Liu Y, Shao Y. Long-term efficacy and safety of sodium-glucose cotransporter-2 inhibitors as add-on to metformin treatment in the management of type 2 diabetes mellitus: a meta-analysis. Medicine. 2017;96(27):e7201. https://doi.org/10.1097/MD.0000000000007201.",
"volume": "96",
"year": "2017"
},
{
"DOI": "10.1016/j.diabres.2014.06.006",
"author": "Q Zhang",
"doi-asserted-by": "publisher",
"first-page": "313",
"issue": "3",
"journal-title": "Diabetes Res Clin Pract",
"key": "1362_CR55",
"unstructured": "Zhang Q, Dou J, Lu J. Combinational therapy with metformin and sodium-glucose cotransporter inhibitors in management of type 2 diabetes: systematic review and meta-analyses. Diabetes Res Clin Pract. 2014;105(3):313–21. https://doi.org/10.1016/j.diabres.2014.06.006.",
"volume": "105",
"year": "2014"
},
{
"DOI": "10.1016/j.ijid.2020.11.157",
"author": "JN Ngiam",
"doi-asserted-by": "publisher",
"first-page": "329",
"journal-title": "Int J Infect Dis",
"key": "1362_CR56",
"unstructured": "Ngiam JN, Chew N, Tham SM, Beh DLL, Lim ZY, Li TYW, et al. Demographic shift in COVID-19 patients in Singapore from an aged, at-risk population to young migrant workers with reduced risk of severe disease. Int J Infect Dis. 2021;103:329–35. https://doi.org/10.1016/j.ijid.2020.11.157.",
"volume": "103",
"year": "2021"
},
{
"DOI": "10.1016/j.ijid.2022.12.007",
"author": "JN Ngiam",
"doi-asserted-by": "publisher",
"first-page": "77",
"journal-title": "Int J Infect Dis",
"key": "1362_CR57",
"unstructured": "Ngiam JN, Chhabra S, Goh W, Sim MY, Chew NW, Sia CH, et al. Continued demographic shifts in hospitalised patients with COVID-19 from migrant workers to a vulnerable and more elderly local population at risk of severe disease. Int J Infect Dis. 2023;127:77–84. https://doi.org/10.1016/j.ijid.2022.12.007.",
"volume": "127",
"year": "2023"
}
],
"reference-count": 57,
"references-count": 57,
"relation": {},
"resource": {
"primary": {
"URL": "https://link.springer.com/10.1007/s40121-026-01362-z"
}
},
"score": 1,
"short-title": [],
"source": "Crossref",
"subject": [],
"subtitle": [],
"title": "Prior SGLT2 Inhibitor and Metformin Use and Risk of Long COVID in Type 2 Diabetes: A Nationwide Population-Based Cohort Study",
"type": "journal-article",
"update-policy": "https://doi.org/10.1007/springer_crossmark_policy"
}
