Effect of Antidiabetic Therapy on Clinical Outcomes of COVID-19 Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis
BS Kegang Zhan, MS Liuqi Weng, PhD Li Qi, BS Luhan Wang, BS Hao Lin, MS Xiaoyu Fang, PhD Hong Jia, PhD Xiangyu Ma
Annals of Pharmacotherapy, doi:10.1177/10600280221133577
Background: No study has yet systematically evaluated the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with type 2 diabetes (T2D). Objective: We aimed to evaluate the effect of different antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D. Methods: We comprehensively retrieved the published research which examined the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D. The odds ratio (OR) and its 95% confidence interval (95% CI) for clinical outcomes were calculated using the random-effects model, and meta-regression was adopted to evaluate the potential sources of heterogeneity between studies. Results: A total of 54 studies were included in this study. We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75). No statistically significant associations were identified for DPP-4i, SUs, AGIs, and TZDs. Conclusion and Relevance: We demonstrated that the usage of metformin, SGLT-2i, and GLP-1ra could significantly decrease mortality in COVID-19 patients with T2D. The heterogeneity across the studies, baseline characteristics of the included patients, shortage of dosage and the duration of antidiabetic drugs and autonomy of drug selection might limit the objectivity and accuracy of results. Further adequately powered and high-quality randomized controlled trials are warranted for conclusive findings.
Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
ORCID iDs Luhan Wang https://orcid.org/0000-0001-7917-9071 Xiangyu Ma https://orcid.org/0000-0001-7967-3950
Supplemental Material Supplemental material for this article is available online.
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'abstract': '<jats:sec><jats:title>Background:</jats:title><jats:p> No study has yet systematically '
'evaluated the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with '
'type 2 diabetes (T2D). '
'</jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> We aimed to '
'evaluate the effect of different antidiabetic therapy on clinical outcomes of COVID-19 '
'patients with T2D. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We '
'comprehensively retrieved the published research which examined the effect of antidiabetic '
'therapy on clinical outcomes of COVID-19 patients with T2D. The odds ratio (OR) and its 95% '
'confidence interval (95% CI) for clinical outcomes were calculated using the random-effects '
'model, and meta-regression was adopted to evaluate the potential sources of heterogeneity '
'between studies. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A '
'total of 54 studies were included in this study. We found that the use of metformin (OR = '
'0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% '
'CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients '
'with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, '
'95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75). No statistically '
'significant associations were identified for DPP-4i, SUs, AGIs, and TZDs. '
'</jats:p></jats:sec><jats:sec><jats:title>Conclusion and Relevance:</jats:title><jats:p> We '
'demonstrated that the usage of metformin, SGLT-2i, and GLP-1ra could significantly decrease '
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'characteristics of the included patients, shortage of dosage and the duration of antidiabetic '
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