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0 0.5 1 1.5 2+ Mortality 1% Improvement Relative Risk Metformin  Ramos-Rincón et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 790 patients in Spain (March - May 2020) No significant difference in mortality Ramos-Rincón et al., Research Square, Dec 2020 Favors metformin Favors control

Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain

Ramos-Rincón et al., Research Square, doi:10.21203/
Dec 2020  
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Retrospective 790 hospitalized type 2 diabetes patients ≥80 years old in Spain, showing no significant difference in mortality with existing metformin use.
This study includes aspirin and metformin.
risk of death, 1.3% lower, RR 0.99, p = 0.78, treatment 206 of 420 (49.0%), control 179 of 370 (48.4%), adjusted per study, odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ramos-Rincón et al., 28 Dec 2020, retrospective, Spain, preprint, 25 authors, study period 1 March, 2020 - 29 May, 2020.
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AI generated summary. Current AI models can provide useful summaries for non-experts, but may be inaccurate and have limited ability to analyze larger context such as the entire evidence base for metformin.

Preadmission treatment with DPP-4 inhibitors and ARBs may reduce in-hospital mortality in very old patients with T2DM hospitalized for COVID-19.

This article is about the association between cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus (T2DM) hospitalized due to COVID-19. The study was conducted in Spain and included 790 patients ≥80 years old with T2DM who were hospitalized for COVID-19 between March 1 and May 29, 2020. The primary outcome was in-hospital mortality.

The results showed that the use of dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) and angiotensin receptor blockers (ARBs) was associated with a lower risk of in-hospital mortality, while the use of acetylsalicylic acid (ASA) was associated with an increased risk of in-hospital mortality. Other antidiabetic drugs, angiotensin-converting enzyme inhibitors (ACE-inhibitors), and statins did not have a significant association with in-hospital mortality.

The authors concluded that preadmission treatment with DPP-4 inhibitors and ARBs may reduce in-hospital mortality in very old patients with T2DM hospitalized for COVID-19. They also suggested that further studies are needed to confirm these findings and to investigate the potential mechanisms underlying these associations.

It is important to note that this study was observational, which means that it cannot prove cause and effect. It is possible that other factors, such as the severity of COVID-19, could have contributed to the observed associations. However, the findings of this study suggest that DPP-4 inhibitors and ARBs may be beneficial for very old patients with T2DM who are hospitalized for COVID-19.

Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain
Jose Manuel Ramos-Rincón, Luis M Pérez-Belmonte, Francisco Javier Carrasco-Sánchez, Sergio Jansen-Chaparro, Mercedes De-Sousa-Baena, José Bueno-Fonseca, Maria Pérez-Aguilar, Coral Arévalo Cañas, Marta Bacete Cebrian, Manuel Méndez-Bailón, Isabel Fiteni Mera, Andrés González García, Francisco Navarro Romero, Carlota Tuñón De Almeida, Gemma Muñiz Nicolás, Amara González Noya, Almudena Hernández Milian, Gema María García García, José Nicolás Alcalá Pedrajas, Virginia Herrero García, Luis Corral-Gudino, Pere Comas Casanova, Héctor Meijide Míguez, José Manuel Casas-Rojo, Ricardo Gómez-Huelgas
Background Advanced age and diabetes are both associated with poor prognosis in COVID-19. However, the effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well-known. This work aims to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥ 80 years with type 2 diabetes mellitus hospitalized for COVID-19. Methods We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years with type 2 diabetes mellitus and COVID-19 hospitalized in 160 Spanish hospitals between March 1 and May 29, 2020 who were included in the SEMI-COVID-19 Registry. The primary outcome measure was inhospital mortality. A multivariate logistic regression analysis were performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality. The regression analysis values were expressed as adjusted odds ratios (AOR) with a 95% con dence interval (CI). In order to select the variables, the forward selection Wald statistic was used. Discrimination of the tted logistic model was assessed via a receiver operating characteristic (ROC) curve. The Hosmer-Lemeshow test for logistic regression was used to determine the model's goodness of t.
Declarations Ethics approval and consent to participate gave their informed consent. When there were biosafety concerns and/or when the patient had already been discharged, verbal informed consent was requested and noted on the medical record. Data con dentiality and patient anonymity were maintained at all times, in accordance with Spanish regulations on observational studies. This study was 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 Committe code: SEMI-COVID-19 27-03-20), as per the guidelines of the Spanish Agency of Medicines and Medical Products. Consent for publication Not applicable. Competing interest The authors declare that they have no competing interests. Authors' contributions JMRR contributed to the conception, design of the work the acquisition, interpretation of data, writingoriginal draft preparation, writing-review and editing, and supervision. FJCS, SJC, MDSB, JBF, MPA, CAC, MBC, MMB, IFM, AGG, FNR, CTA, GMN, AGN, AHM, GMGG, JNAP, VHG, LCG, PCC, HMM, and JMCR made contributions to the acquisition of data and revised the work. LMPB contributed to interpretation of data, writing-review and editing, and supervision. RGH was a major contributor in interpretation of data, writingoriginal draft preparation, writing-review and editing, and supervision. All authors read and approved the nal manuscript. Supplementary Files This is a list of..
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