Association Between Metformin Use and Mortality Among Patients with Type 2 Diabetes Mellitus Hospitalized for COVID-19 Infection
Ong et al.
, Association Between Metformin Use and Mortality Among Patients with Type 2 Diabetes Mellitus Hospitalized for..
, Journal of the ASEAN Federation of Endocrine Societies, doi:10.15605/jafes.036.02.20
Retrospective 355 diabetic hospitalized COVID-19 patients in the Philippines, showing lower mortality with metformin use.
risk of death, 46.8% lower, RR 0.53, p = 0.02, treatment 33 of 186 (17.7%), control 57 of 169 (33.7%), NNT 6.3, adjusted per study, odds ratio converted to relative risk, combined pre-existing and in-hospital use.
risk of death, 23.9% lower, RR 0.76, p = 0.16, treatment 28 of 109 (25.7%), control 57 of 169 (33.7%), NNT 12, odds ratio converted to relative risk, pre-existing use, unadjusted.
risk of death, 85.2% lower, RR 0.15, p = 0.002, treatment 2 of 40 (5.0%), control 57 of 169 (33.7%), NNT 3.5, odds ratio converted to relative risk, in-hospital use, unadjusted.
risk of death, 76.0% lower, RR 0.24, p = 0.005, treatment 3 of 37 (8.1%), control 57 of 169 (33.7%), NNT 3.9, odds ratio converted to relative risk, mixed pre-existing/in-hospital use, unadjusted.
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Ong et al., 30 Oct 2021, retrospective, Philippines, peer-reviewed, 6 authors, study period 1 March, 2020 - 30 September, 2020.
Abstract: Original Article
Journal of the
ASEAN Federation of
Association Between Metformin Use and Mortality among Patients
with Type 2 Diabetes Mellitus Hospitalized for COVID-19 Infection
Angeli Nicole Ong,1 Ceryl Cindy Tan,1 Maria Teresa Cañete,2 Bryan Albert Lim,3 Jeremyjones Robles1,4
Section of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Chong Hua Hospital, Cebu City, Philippines
Section of Neurology, Department of Internal Medicine, Chong Hua Hospital, Cebu City, Philippines
Section of Infectious Diseases, Department of Internal Medicine, Chong Hua Hospital, Cebu City, Philippines
Department of Internal Medicine, Cebu Institute of Medicine – Cebu Velez General Hospital, Cebu City, Philippines
Introduction. Metformin has known mechanistic benefits on COVID-19 infection due to its anti-inflammatory effects and
its action on the ACE2 receptor. However, some physicians are reluctant to use it in hypoxemic patients due to potential
lactic acidosis. The primary purpose of the study was to determine whether metformin use is associated with survival.
We also wanted to determine whether there is a difference in outcomes in subcategories of metformin use, whether at
home, in-hospital, or mixed home/in-hospital use.
Objectives. This study aimed to determine an association between metformin use and mortality among patients with
type 2 diabetes mellitus hospitalized for COVID-19 infection.
Methodology. This was a cross-sectional analysis of data acquired from the COVID-19 database of two tertiary hospitals
in Cebu from March 1, 2020, to September 30, 2020. Hospitalized adult Filipino patients with type 2 diabetes mellitus
who tested positive for COVID-19 via RT-PCR were included and categorized as either metformin users or metformin
Results. We included 355 patients with type 2 diabetes mellitus in the study, 186 (52.4%) were metformin users. They
were further categorized into home metformin users (n=109, 30.7%), in-hospital metformin users (n=40, 11.3%), and
mixed home/in-hospital metformin users (n=37, 10.4%). Metformin use was associated with a lower risk for mortality
compared to non-users (p=0.001; OR=0.424). In-hospital and mixed home/in-hospital metformin users were associated
with lower mortality odds than non-users (p=0.002; OR=0.103 and p=0.005; OR 0.173, respectively). The lower risk for
mortality was noted in metformin, regardless of dosage, from 500 mg to 2 g daily (p=0.002). Daily dose between ≥1000
mg to <2000 mg was associated with the greatest benefit on mortality (p≤0.001; OR=0.252). The survival distributions
between metformin users and non-users were statistically different, showing inequality in survival (χ2=5.67, p=0.017).
Conclusion. Metformin was associated with a lower risk for mortality in persons with type 2 diabetes mellitus hospitalized
for COVID-19 disease compared to non-users. Use of metformin in-hospital, and mixed home/in-hospital metformin
use, was also associated with decreased risk for mortality. The greatest benefit seen was in those taking a daily dose
of ≥1000 mg to <2000 mg.
Key words: metformin, diabetes mellitus, COVID-19, mortality
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