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Effects of different treatments for type 2 diabetes mellitus on mortality of coronavirus disease from 2019 to 2021 in China: a multi-institutional retrospective study

Xu et al., Molecular Biomedicine, doi:10.1186/s43556-024-00183-1
May 2024  
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Mortality, PSM 52% Improvement Relative Risk Mortality 59% Ventilation 54% ARDS 72% Metformin for COVID-19  Xu et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 4,922 patients in China Lower mortality (p=0.014) and ventilation (p=0.007) c19early.org Xu et al., Molecular Biomedicine, May 2024 Favorsmetformin Favorscontrol 0 0.5 1 1.5 2+
Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020, now with p < 0.00000000001 from 98 studies.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 111 treatments. c19early.org
Retrospective 4,922 COVID-19 patients with type 2 diabetes in China, showing lower mortality with metformin and alpha-glucosidase inhibitor treatment and higher mortality with insulin treatment.
risk of death, 52.0% lower, HR 0.48, p = 0.01, treatment 405, control 405, adjusted per study, propensity score matching, multivariable, Cox proportional hazards.
risk of death, 59.0% lower, HR 0.41, p = 0.001, treatment 466, control 4,456, adjusted per study, multivariable, Cox proportional hazards.
risk of mechanical ventilation, 54.0% lower, HR 0.46, p = 0.007, treatment 466, control 4,456, adjusted per study, multivariable, Cox proportional hazards, Table S7.
risk of ARDS, 72.0% lower, HR 0.28, p = 0.04, treatment 466, control 4,456, adjusted per study, multivariable, Cox proportional hazards, Table S7.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Xu et al., 17 May 2024, retrospective, China, peer-reviewed, 6 authors. Contact: dwwang@tjh.tjmu.edu.cn.
This PaperMetforminAll
Effects of different treatments for type 2 diabetes mellitus on mortality of coronavirus disease from 2019 to 2021 in China: a multi-institutional retrospective study
Ke Xu, Wu He, Bo Yu, Kaineng Zhong, Da Zhou, Dao Wen Wang
Molecular Biomedicine, doi:10.1186/s43556-024-00183-1
The coronavirus disease (COVID-19) pandemic has continued for 5 years. Sporadic cases continue to occur in different locations. Type 2 diabetes mellitus (T2DM) is associated with a high risk of a poor prognosis in patients with COVID-19. Successful control of blood glucose levels can effectively decrease the risks of severe infections and mortality. However, the effects of different treatments were reported differently and even adversely. This retrospective study included 4,922 patients who have been diagnosed as COVID-19 and T2DM from 138 Hubei hospitals. The clinical characteristics and outcomes were compared and calculated their risk for death using multivariate Cox regression and Kaplan-Meier curves. After adjustment of age, sex, comorbidities, and in-hospital medications, metformin and alpha-glucosidase inhibitor (AGI) use performed lower all-cause mortality (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI]: 0.24-0.71; p = 0.001 for metformin; 0.53, 0.35-0.80, p = 0.002 for AGIs), while insulin use was associated with increased all-cause mortality (adjusted HR, 2.07, 95% CI, 1.61-2.67, p < 0.001). After propensity score-matched (PSM) analysis, adjusted HRs for insulin, metformin, and AGIs associated with all-cause mortality were 1.32 (95% CI, 1.03-1.81; p = 0.012), 0.48 (95% CI, 0.23-0.83, p = 0.014), and 0.59 (95% CI, 0.35-0.98, p = 0.05). Therefore, metformin and AGIs might be more suitable for patients with COVID-19 and T2DM while insulin might be used with caution.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s43556-024-00183-1. Supplementary Material 1. Authors' contributions KX designed the study, collected and analyzed data, performed the statistical analysis, and wrote the manuscript. WH, BY, KZ and DZ completed the data collation and was responsible for quality control. DWW designed the project, edited the manuscript, and supervised the study. All authors have read and approved the final manuscript. Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of Tongji Medical College (no. TJ-IRB20210138). Owing to the retrospective nature and anonymity in this study, the Research Ethics Committee of Tongji Medical College waived the requirement for obtaining written informed consent. Competing interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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' '2019;35(6):e3158. https://doi.org/10.1002/dmrr.3158.', 'journal-title': 'Diabetes Metab Res Rev'}], 'container-title': 'Molecular Biomedicine', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s43556-024-00183-1.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s43556-024-00183-1/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s43556-024-00183-1.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2024, 5, 17]], 'date-time': '2024-05-17T00:02:55Z', 'timestamp': 1715904175000}, 'score': 1, 'resource': {'primary': {'URL': 'https://link.springer.com/10.1186/s43556-024-00183-1'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 5, 17]]}, 'references-count': 40, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2024, 12]]}}, 'alternative-id': ['183'], 'URL': 'http://dx.doi.org/10.1186/s43556-024-00183-1', 'relation': {}, 'ISSN': ['2662-8651'], 'subject': [], 'container-title-short': 'Mol Biomed', 'published': {'date-parts': [[2024, 5, 17]]}, 'assertion': [ { 'value': '27 November 2023', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '12 April 2024', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '17 May 2024', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'This study was conducted in accordance with the principles of the Declaration ' 'of Helsinki and approved by the Research Ethics Committee of Tongji Medical ' 'College (no. TJ-IRB20210138). Owing to the retrospective nature and anonymity ' 'in this study, the Research Ethics Committee of Tongji Medical College waived ' 'the requirement for obtaining written informed consent.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'The author(s) declared no potential conflicts of interest with respect to the ' 'research, authorship, and/or publication of this article.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '18'}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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