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0 0.5 1 1.5 2+ Mortality 22% Improvement Relative Risk Metformin for COVID-19  Shestakova et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 189,998 patients in Russia (March 2020 - November 2021) Lower mortality with metformin (p=0.0012) Shestakova et al., Frontiers in Endocr.., Aug 2022 Favors metformin Favors control

Risk factors for COVID-19 case fatality rate in people with type 1 and type 2 diabetes mellitus: A nationwide retrospective cohort study of 235,248 patients in the Russian Federation

Shestakova et al., Frontiers in Endocrinology, doi:10.3389/fendo.2022.909874
Aug 2022  
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Retrospective 224,190 type 2 diabetes patients in Russia, showing lower mortality with metformin use.
risk of death, 21.6% lower, RR 0.78, p = 0.001, treatment 21,471 of 139,637 (15.4%), control 12,721 of 50,361 (25.3%), adjusted per study, odds ratio converted to relative risk, Table S2, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Shestakova et al., 9 Aug 2022, retrospective, Russia, peer-reviewed, 6 authors, study period 20 March, 2020 - 25 November, 2021.
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Risk factors for COVID-19 case fatality rate in people with type 1 and type 2 diabetes mellitus: A nationwide retrospective cohort study of 235,248 patients in the Russian Federation
M V Shestakova, O K Vikulova, A R Elfimova, A A Deviatkin, I I Dedov, N G Mokrysheva
Frontiers in Endocrinology, doi:10.3389/fendo.2022.909874
The aim: To study the association of demographic, clinical, and laboratory factors and the use of glucose-lowering drugs and anti-coronavirus disease (COVID-19) vaccination with the COVID-19-related case fatality rate (CFR) in diabetes mellitus (DM) patients. Methods: This study is a nationwide observational cohort study based on the data from the National Diabetes Register (NDR) that is the database containing online clinical information about the population with DM. The outcomes (death or recovery) for COVID-19 were registered in 235,248 patients with DM [type 1 diabetes mellitus (T1DM), n = 11,058; type 2 diabetes mellitus (T2DM), n = 224,190] from March 20, 2020, until November 25, 2021. The unadjusted odds ratio (OR) and 95% confidence interval (CI) were used to estimate the risk factors for CFR. Then the ranging of significant factors was performed and the most vulnerable groups of factors for the lethal outcome were chosen. Results: The CFR due to COVID-19 was 8.1% in T1DM and 15.3% in T2DM. Increased CFR was associated with the male population [OR = 1.25 (95% CI: 1.09-1.44) in T1DM and 1.18 (95% CI: 1.15-1.21) in T2DM], age ≥65 years [OR = 4.44 (95% CI: 3.75-5.24) in T1DM and 3.18 (95% CI: 3.09-3.26) in T2DM], DM duration ≥10 years [OR = 2.46 (95% CI: 2.06-2.95) in T1DM and 2.11 (95% CI: 2.06-2.16) in T2DM], body mass index (BMI) ≥30 kg/m 2 [OR = 1.95 (95% CI: 1.52-2.50)] in T1DM, HbA1c ≥7% [OR = 1.35 (95% CI: 1.29-1.43)] in T2DM. The atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) were associated with higher CFR in T1DM but not in T2DM. The pre-COVID-19 glucose-lowering therapy in T2DM was differently associated with CFR (OR): 0.61 (95% CI: 0.59-0.62) for metformin, 0.59 (95% CI: 0.57-0.61) for dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), 0.46 (95% CI: 0.44-0.49) for sodium-glucose co-transporter-2 (SGLT2) inhibitors, 0.38 (95% CI: 0.29-0.51) for glucagon-like peptide-1 receptor agonists (arGLP-1), 1.34 (95% CI: 1.31-1.37) for sulfonylurea (SU), and 1.47 (95% CI: 1.43-1.51) for insulin. Anti-Frontiers in Endocrinology 01
Ethics statement The studies involving human participants (human data of register medical reports) were reviewed and approved by local ethics committee of Endocrinology Research Centre, Moscow, Russia. The patients/participants provided their written informed consent for use of medical data register records for the study. Author contributions MS, OV, ID and NM conceived and designed the study. AE, AD, and OV analyzed the data. OV, AD, AE, MS wrote the paper. ID and NM have done final revision of article. All authors, reviewed, edited, and approved the manuscript. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Supplementary material The Supplementary Material for this article can be found online at: fendo.2022.909874/full#supplementary-material
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