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0 0.5 1 1.5 2+ Mortality -1% Improvement Relative Risk Ventilation -4% ICU admission 8% Metformin  Obiri-Yeboah et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 529 patients in the USA No significant difference in outcomes seen Obiri-Yeboah et al., Endocrine Practice, Jun 2023 Favors metformin Favors control

Association of metformin, dipeptidyl dipeptidase-4 inhibitors, and insulin with COVID-19-related hospital outcomes in patients with type 2 diabetes

Obiri-Yeboah et al., Endocrine Practice, doi:10.1016/j.eprac.2023.06.001
Jun 2023  
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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.
3,800+ studies for 60+ treatments.
Retrospective 529 hospitalized COVID-19 patients with type 2 diabetes, showing no significant difference in outcomes with metformin use. This does not account for the different risk of being hospitalized based on metformin use.
Authors note that "there is a lower-than-expected proportion of metformin prescription in our population (28%) compared to the general US population", without noting that this may reflect the lower risk of being hospitalized for metformin patients, as shown in other studies
risk of death, 1.0% higher, OR 1.01, p = 0.98, treatment 148, control 381, RR approximated with OR.
risk of mechanical ventilation, 4.0% higher, OR 1.04, p = 0.87, treatment 148, control 381, RR approximated with OR.
risk of ICU admission, 8.0% lower, OR 0.92, p = 0.72, treatment 148, control 381, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Obiri-Yeboah et al., 8 Jun 2023, retrospective, USA, peer-reviewed, mean age 67.0, 8 authors. Contact:
This PaperMetforminAll
Association of metformin, dipeptidyl dipeptidase-4 inhibitors, and insulin with COVID-19-related hospital outcomes in patients with type 2 diabetes
BS Derrick Obiri-Yeboah, MS James Bena, MD Mahmoud Alwakeel, MD, MPH Lauren Buehler, MD, FACE Vinni Makin, MD Keren Zhou, DO, FACE, M Kevin M Pantalone, MD, MPH M Cecilia Lansang
Endocrine Practice, doi:10.1016/j.eprac.2023.06.001
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Bassendine, Bridge, Mccaughan, Gorrell, COVID-19 and comorbidities: A role for dipeptidyl peptidase 4 (DPP4) in disease severity?, J Diabetes, doi:10.1111/1753-0407.13052
Bramante, Ingraham, Murray, Observational study of metformin and risk of mortality in patients hospitalized with Covid-19, doi:10.1101/2020.06.19.20135095
Chen, Yang, Cheng, Clinical characteristics and outcomes of patients with diabetes and COVID-19 in association with glucose-lowering medication, Diabetes Care, doi:10.2337/dc20-0660
Crouse, Grimes, Li, Might, Ovalle et al., Metformin use is associated with reduced mortality in a diverse population with covid-19 and diabetes, Frontiers in Endocrinology, doi:10.3389/fendo.2020.600439
Han, Ma, Sun, Association between anti-diabetic agents and clinical outcomes of COVID-19 in patients with diabetes: A systematic review and meta-analysis, Arch Med Res, doi:10.1016/j.arcmed.2021.08.002
Jehi, Ji, Milinovich, Individualizing Risk Prediction for Positive Coronavirus Disease 2019 Testing, Chest
Khunti, Knighton, Zaccardi, Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England, The Lancet Diabetes & Endocrinology, doi:10.1016/S2213-8587
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Luo, Qiu, Liu, Metformin treatment was associated with decreased mortality in COVID-19 patients with diabetes in a retrospective analysis, Am J Trop Med Hyg, doi:10.4269/ajtmh.20-0375
Mirani, Favacchio, Carrone, Impact of comorbidities and glycemia at admission and dipeptidyl peptidase 4 inhibitors in patients with type 2 diabetes with COVID-19: A case series from an academic hospital in Lombardy, Italy. Diabetes Care, doi:10.2337/dc20-1340
Nauck, Meier, Reduced COVID-19 mortality with sitagliptin Treatment? Weighing the dissemination of potentially lifesaving findings against the assurance of high scientific standards, Diabetes Care, doi:10.2337/dci20-0062
Prattichizzo, De Candia, Nicolucci, Ceriello, Elevated HbA1c levels in pre-Covid-19 infection increases the risk of mortality: A sistematic review and meta-analysis, Diabetes Metab Res Rev, doi:10.1002/dmrr.3476
Solerte, 'addio, Trevisan, Sitagliptin treatment at the time of hospitalization was associated with reduced mortality in patients with Type 2 Diabetes and COVID-19: A multicenter, case-control, retrospective, observational Study, Diabetes Care, doi:10.2337/dc20-1521
Wander, Lowy, Beste, Prior glucose-lowering medication use and 30-day outcomes among 64,892 veterans with diabetes and COVID-19, Diabetes Care, doi:10.2337/dc21-1351
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