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Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland

Yeh et al., BMJ Open Diabetes Research & Care, doi:10.1136/bmjdrc-2022-002774, NCT02788903
Jun 2022  
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ICU/intubation/death 44% Improvement Relative Risk Hospitalization 37% Metformin for COVID-19  Yeh et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective study in the USA (March 2020 - February 2021) Lower progression (p<0.0001) and hospitalization (p<0.0001) c19early.org Yeh et al., BMJ Open Diabetes Research.., Jun 2022 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 93 studies.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 81 treatments. c19early.org
Retrospective 4,944 COVID-19 patients with type 2 diabetes in the USA, showing lower risk of hospitalization and combined ICU/intubation/death with metformin use.
ICU/intubation/death, 44.0% lower, OR 0.56, p < 0.001, RR approximated with OR.
risk of hospitalization, 37.0% lower, OR 0.63, p < 0.001, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Yeh et al., 9 Jun 2022, retrospective, USA, peer-reviewed, mean age 62.3, 9 authors, study period 1 March, 2020 - 28 February, 2021, trial NCT02788903 (history). Contact: hyeh1@jhmi.e.
This PaperMetforminAll
Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland
Hsin-Chieh Yeh, Jennifer L Kraschnewski, Lan Kong, Erik B Lehman, Emily S Heilbrunn, Pamela Williams, Jennifer M Poger, Erica Francis, Cindy L Bryce
BMJ Open Diabetes Research & Care, doi:10.1136/bmjdrc-2022-002774
Objective To identify the demographic and clinical characteristics associated with adverse COVID-19 outcomes across a 12-month period in 2020 and 2021. Research design and methods We conducted a retrospective cohort study using electronic health records from five academic health systems in Pennsylvania and Maryland, including patients with COVID-19 with type 2 diabetes or at risk of type 2 diabetes. Patients were classified based on 30-day outcomes: (1) no hospitalization; (2) hospitalization only; or (3) a composite measure including admission to the intensive care unit (ICU), intubation, or death. Analyses were conducted in patients with type 2 diabetes and patients at risk of type 2 diabetes separately. Results We included 15 725 patients with COVID-19 diagnoses between March 2020 and February 2021. Older age and higher Charlson Comorbidity Index scores were associated with higher odds of adverse outcomes, while COVID-19 diagnoses later in the study period were associated with lower odds of severe outcomes. In patients with type 2 diabetes, individuals on insulin treatment had higher odds for ICU/intubation/death (OR=1.59, 95% CI 1.27 to 1.99), whereas those on metformin had lower odds (OR=0.56, 95% CI 0.45 to 0.71). Compared with non-Hispanic White patients, Hispanic patients had higher odds of hospitalization in patients with type 2 diabetes (OR=1.73, 95% CI 1.36 to 2.19) or at risk of type 2 diabetes (OR=1.77, 95% CI 1.43 to 2.18.) Conclusions Adults who were older, in racial minority groups, had multiple chronic conditions or were on insulin treatment had higher risks for severe COVID-19 outcomes. This study reinforced the urgency of preventing COVID-19 and its complications in vulnerable populations. Trial registration number NCT02788903. ⇒ This study reinforced the urgency of prevent-
Competing interests None declared. Patient consent for publication Not required. Ethics approval This study was reviewed and approved by the Institutional Review Board (IRB) of Johns Hopkins School of Medicine, the central IRB for all participating institutions. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. The data sets generated and/ or analyzed during the current study are not publicly available due to data sharing agreements with electronic health record data. However, opportunities exist for collaborations with the PaTH Network. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others..
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Diabetes Care 2022;24:dc212186.', 'DOI': '10.2337/figshare.19119302'}, { 'key': '2022060909200758000_10.3.e002774.37', 'doi-asserted-by': 'crossref', 'DOI': '10.1002/dmrr.3398', 'article-title': 'Haemoglobin A1c is a predictor of COVID-19 severity in patients with ' 'diabetes', 'volume': '37', 'author': 'Merzon', 'year': '2021', 'journal-title': 'Diabetes Metab Res Rev'}, { 'key': '2022060909200758000_10.3.e002774.38', 'doi-asserted-by': 'crossref', 'first-page': '823', 'DOI': '10.1016/S2213-8587(20)30271-0', 'article-title': 'Risk factors for COVID-19-related mortality in people with type 1 and ' 'type 2 diabetes in England: a population-based cohort study', 'volume': '8', 'author': 'Holman', 'year': '2020', 'journal-title': 'Lancet Diabetes Endocrinol'}, { 'key': '2022060909200758000_10.3.e002774.39', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bmjopen-2021-052777'}], 'container-title': 'BMJ Open Diabetes Research &amp; Care', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://syndication.highwire.org/content/doi/10.1136/bmjdrc-2022-002774', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 6, 9]], 'date-time': '2022-06-09T16:21:03Z', 'timestamp': 1654791663000}, 'score': 1, 'resource': {'primary': {'URL': 'https://drc.bmj.com/lookup/doi/10.1136/bmjdrc-2022-002774'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 6]]}, 'references-count': 39, 'journal-issue': { 'issue': '3', 'published-online': {'date-parts': [[2022, 6, 9]]}, 'published-print': {'date-parts': [[2022, 6]]}}, 'alternative-id': ['10.1136/bmjdrc-2022-002774'], 'URL': 'http://dx.doi.org/10.1136/bmjdrc-2022-002774', 'relation': {}, 'ISSN': ['2052-4897'], 'subject': ['Endocrinology, Diabetes and Metabolism'], 'container-title-short': 'BMJ Open Diab Res Care', 'published': {'date-parts': [[2022, 6]]}}
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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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