Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: a nationwide cohort study

{ 'indexed': {'date-parts': [[2022, 1, 8]], 'date-time': '2022-01-08T19:27:33Z', 'timestamp': 1641670053885}, 'reference-count': 33, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2020, 11, 16]], 'date-time': '2020-11-16T00:00:00Z', 'timestamp': 1605484800000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}, { 'start': { 'date-parts': [[2020, 11, 16]], 'date-time': '2020-11-16T00:00:00Z', 'timestamp': 1605484800000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'short-container-title': ['BMC Med'], 'published-print': {'date-parts': [[2020, 12]]}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Limited ' 'evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main ' 'objective was to examine the association between in-hospital death and each routine at-home ' 'glucose-lowering drug both individually and in combination with metformin in patients with ' 'type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the ' 'composite outcome of the need for ICU admission, invasive and non-invasive mechanical ' 'ventilation, or in-hospital death as well as on the development of in-hospital complications ' 'and a long-time hospital ' 'stay.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We selected all ' 'patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine’s registry ' 'of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, ' 'nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each ' 'glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 ' 'manner by propensity scores. In order to assess the adequacy of propensity score matching, we ' 'used the standardized mean difference found in patient characteristics after matching. There ' 'was considered to be a significant imbalance in the group if a standardized mean difference ' '&gt;\u200910% was found. To evaluate the association between treatment and study outcomes, ' 'both conditional logit and mixed effect logistic regressions were used when the sample size ' 'was ≥\u2009100.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total ' 'of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in ' 'monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on ' 'metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on ' 'metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 ' 'inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs ' 'showed a significant association with in-hospital death; the composite outcome of the need of ' 'intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital ' 'complications; or long-time hospital ' 'stays.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In patients ' 'with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no ' 'significant association with mortality and adverse outcomes. Given the close relationship ' 'between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, ' 'prospective studies are needed.</jats:p></jats:sec>', 'DOI': '10.1186/s12916-020-01832-2', 'type': 'journal-article', 'created': { 'date-parts': [[2020, 11, 16]], 'date-time': '2020-11-16T02:03:53Z', 'timestamp': 1605492233000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 41, 'title': [ 'Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for ' 'COVID-19 in association with glucose-lowering drugs: a nationwide cohort study'], 'prefix': '10.1186', 'volume': '18', 'author': [ {'given': 'Luis M.', 'family': 'Pérez-Belmonte', 'sequence': 'first', 'affiliation': []}, {'name': 'for the SEMI-COVID-19 Network', 'sequence': 'first', 'affiliation': []}, {'given': 'José David', 'family': 'Torres-Peña', 'sequence': 'additional', 'affiliation': []}, {'given': 'María D.', 'family': 'López-Carmona', 'sequence': 'additional', 'affiliation': []}, {'given': 'M. 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Data confidentiality ' 'and patient anonymity were maintained at all times, in accordance with Spanish ' 'regulations on observational studies. Patient-identifying information was ' 'deleted before the database was analyzed. It is not possible to identify ' 'patients on an individual level either in this article or in the database. This ' 'study was also carried out in accordance with the Declaration of Helsinki and ' 'was approved by the Institutional Research Ethics Committee of Málaga on March ' '27, 2020 (Ethics Committee code: SEMI-COVID-19 27-03-20), as per the guidelines ' 'of the Spanish Agency of Medicines and Medical Products.', 'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'Not applicable.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare that they have no competing interests.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '359'}