Abstract
AimsType 2 diabetes mellitus (T2DM) is a strong risk factor for complications of coronavirus disease 2019 (COVID‐19). The effect of T2DM medications on COVID‐19 outcomes remains unclear. In a retrospective analysis of a cohort of 131 patients with T2DM hospitalized for COVID‐19 in Wuhan, we have previously found that metformin use prior to hospitalization is associated with reduced mortality. The current study aims to investigate the effects of inpatient use of T2DM medications, including metformin, acarbose, insulin and sulfonylureas, on the mortality of COVID‐19 patients with T2DM during hospitalization.MethodsWe continue to carry out a retrospective analysis of a cohort of 131 patients with T2DM hospitalized for COVID‐19 and treated with different combinations of diabetes medications.ResultsWe found that patients using metformin (p = .02) and acarbose (p = .04), alone or both together (p = .03), after admission were significantly more likely to survive than those who did not use either metformin or acarbose. 37 patients continued to take metformin after admission and 35 (94.6%) survived. Among the 57 patients who used acarbose after admission, 52 survived (91.2%). A total of 20 patients used both metformin and acarbose, while 57 used neither. Of the 20 dual‐use patients, 19 (95.0%) survived.ConclusionOur analyses suggest that inpatient use of metformin and acarbose together or alone during hospitalization should be studied in randomized trials.
Highlights
COVID-19 has had devastating consequences for many patients globally
We have previously reported the characteristics of a cohort of 131 COVID-19 patients with Type 2 diabetes mellitus (T2DM) measured at admission, including age, BMI, serum glucose concentration, and oxygen saturation 6
When medication use after admission was analyzed for this cohort of patients, significant associations with survival were found for both metformin (p = 0.02) and acarbose use (p = 0.04), but not for insulin, and sulfonylurea (Table 1)
Summary
COVID-19 has had devastating consequences for many patients globally. At present remdesivir and dexamethasone are the only proven therapies 1, 2; therapeutic advances are still required. A number of risk factors for COVID-19 have been reported including COPD, diabetes, obesity, advanced age, hypertension and other factors 3–5. The elucidation of mechanisms underlying these risk factors may have benefits for stratification of high risk patients and may help to guide pharmacological targets for afflicted patients. The optimal therapy from the perspective of COVID-19 is unclear. We have recently reported an association between pre-hospitalization metformin use and improved risk of mortality, leading us to consider the impact of inpatient pharmacotherapy 6. Inpatient therapy for glucose control in the US typically involves discontinuation of oral agents upon admission and initiation of insulin therapy 7
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