IDF21-0123 Impact of Pre-existing Oral Antidiabetic Treatment on Clinical Outcomes of COVID-19: a Retrospective Study

Abstract

Background: COVID-19 pandemic has affected vast population across the world. Several recent reports have indicated that diabetic patients are at a higher risk of developing a serious COVID. The inflammatory process associated with diabetes, as well as chronically elevated blood glucose levels, can result in a weakened immune response, which can exacerbate infections in diabetic patients. Because of the risk of lactic acidosis in the context of multi-organ dysfunction, including hepatic and renal failure, the majority of expert consensus to date has recommended avoiding metformin in COVID-19 patients with diabetes. On the other hand, several studies have shown that patients taking metformin can have a better outcome. As a result, further research is needed to determine the true impact of oral antidiabetic medication in diabetic COVID-19 patients. Aim: The aim of the study is to observe the effect of pre-existing oral antidiabetic therapy on COVID 19 clinical outcomes and to provide further information to help better clinical decisions pertaining to diabetes management during COVID 19. Method: The study enrolled 150 diabetic patients infected with COVID-19 from the duration of July 2020 to December 2020. 75 (metformin group) of these patients were on metformin therapy for their diabetes (alone or in combination with other medications). The remaining 75 patients (non-metformin group) were given one or more non-metformin antidiabetic drugs. A retrospective observational analysis was done for in-patient data gathered from medical records or the hospital information centre of Parul sevashram hospital, Vadodara, Gujarat, and clinical outcomes were recorded in a data collection form. The information gathered was examined and statistically analysed. Results: We found no significant difference in the age and gender of patients between the groups. There was no correlation observed between glycemic control (HbA1c level) and the severity of Covid-19. There was also a significant difference (odds ratio, 10.6, P=0.0003) observed among severity of the disease between the groups, Metformin 17 patients were found to be moderately ill as compared to non-metformin users (n=2, with moderate illness). There was no difference between Metformin or non metformin treated groups pertaining to their requirement of oxygen support (P = 1.00) as well as duration of hospital stay (P=0.78). However, there were few important differences found in the haematological parameters of the groups, such as lower platelet count (P=0.02), Serum creatinine level (P=0.0049), neutrophil count (P=0.001), HbA1C level (P=0.01), and fasting blood glucose level (P=0.05) were observed in the metformin treated patients. Use of methyl prednisolone demonstrated positive correlation with hyperglycemia when tested using multivariate analysis. No correlation between random blood sugar level and duration of hospital stay was found. Discussion: Our study concluded, contrary to the previous study, that there was a larger proportion of metformin-treated patients with greater severity as compared to non-metformin users. We also found a positive correlation between the use of methylprednisolone and the occurrence of hyperglycemia.