Metformin Use in Relation to Clinical Outcomes and Hyperinflammatory Syndrome Among COVID-19 Patients With Type 2 Diabetes: A Propensity Score Analysis of a Territory-Wide Cohort
Carlos K H Wong, David T W Lui, Angel Y C Lui, Marshall C H Low, Ashley C Y Kwok, Kristy T K Lau, Ivan C H Au, Xi Xiong, Matthew S H Chung, Eric H Y Lau, Benjamin J Cowling
Frontiers in Endocrinology, doi:10.3389/fendo.2022.810914
This study was conducted in order to evaluate the association between metformin use and clinical outcomes in type 2 diabetes mellitus (T2DM) patients hospitalized with coronavirus disease 2019 . Methods: Patients with T2DM with confirmed diagnosis of COVID-19 and admitted between January 21, 2020, and January 31, 2021 in Hong Kong were identified in our cohort. Exposure was defined as metformin use within 90 days prior to admission until hospital discharge for COVID-19. Primary outcome was defined as clinical improvement of ≥1 point on the WHO Clinical Progression Scale (CPS). Other outcomes were hospital discharge, recovery, in-hospital death, acidosis, hyperinflammatory syndrome, length of hospitalization, and changes in WHO CPS score. Results: Metformin use was associated with greater odds of clinical improvement (OR = 2.74, p = 0.009), hospital discharge (OR = 2.26, p = 0.009), and recovery (OR = 2.54, p = 0.005), in addition to lower odds of hyperinflammatory syndrome (OR = 0.71, p = 0.021) and death (OR = 0.41, p = 0.010) than control. Patients on metformin treatment had a shorter hospital stay (−2.76 days, p = 0.017) than their control counterparts. The average WHO CPS scores were significantly lower in metformin users than non-users since day 15 (p < 0.001). However, metformin use was associated with higher odds of acidosis. Conclusions: Metformin use was associated with lower mortality and lower odds for hyperinflammatory syndrome. This provides additional insights into the potential mechanisms of the benefits of metformin use in T2DM patients with COVID-19.
ETHICS STATEMENT The study protocol was approved by the Institutional Review Board of the University of Hong Kong/ Hospital Authority Hong Kong West Cluster (Reference No. . Given the extraordinary nature of the COVID-19 pandemic, individual patient informed consent was not required for this retrospective cohort study using anonymized data.
AUTHOR CONTRIBUTIONS CW reviewed the literature, designed the statistical analysis, conducted the analyses, and wrote the manuscript. DL, AL, AK, ML, and KL reviewed the literature, contributed to the
SUPPLEMENTARY MATERIAL The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fendo.2022.
810914/full#supplementary-material 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.
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'abstract': '<jats:sec><jats:title>Aim</jats:title><jats:p>This study was conducted in order to evaluate '
'the association between metformin use and clinical outcomes in type 2 diabetes mellitus '
'(T2DM) patients hospitalized with coronavirus disease 2019 '
'(COVID-19).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients '
'with T2DM with confirmed diagnosis of COVID-19 and admitted between January 21, 2020, and '
'January 31, 2021 in Hong Kong were identified in our cohort. Exposure was defined as '
'metformin use within 90 days prior to admission until hospital discharge for COVID-19. '
'Primary outcome was defined as clinical improvement of ≥1 point on the WHO Clinical '
'Progression Scale (CPS). Other outcomes were hospital discharge, recovery, in-hospital death, '
'acidosis, hyperinflammatory syndrome, length of hospitalization, and changes in WHO CPS '
'score.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Metformin use was '
'associated with greater odds of clinical improvement (OR = 2.74, <jats:italic>p</jats:italic> '
'= 0.009), hospital discharge (OR = 2.26, <jats:italic>p</jats:italic> = 0.009), and recovery '
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'acidosis.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Metformin '
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