Diabetes Medications Might Play Role in Risk of COVID-19 Mortality

Metformin appears to reduce mortality risks for diabetes patients infected with SARS-CoV-2 but use of insulin – possibly because that is a marker for more advanced disease – seems to increase the risk of death. Find out what else a meta-analysis determined about mortality risks for diabetes patients with COVID-19.

DUSSELDORF, GERMANY – What medications patients use to treat their diabetes appear to be a factor in their risk of dying from infection with SARS-CoV-2, according to a new meta-analysis.

The systematic review and meta-analysis was published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]). Overall, it indicates that patients with a more advanced course of diabetes have a higher risk of death when infected with COVID-19.

https://link.springer.com/article/10.1007/s00125-021-05458-8

German researchers from Heinrich Heine University and colleagues reached that conclusion from review and analysis of 22 studies involving 17,687 patients. The authors point out that associations with COVID-19 related death weren’t much different in diabetes patients from those in found in the general population without diabetes.

In essence, researchers advise that men with diabetes were 28% more likely to die with COVID-19 than women with diabetes, and diabetes patients older than 65 were more than three times more likely to die than those under that age with diabetes. With each 5-year increase in age, the relative risk for COVID-19 related death in people living with diabetes increased by 43%, the authors add.

While only few of the 22 studies investigated diabetes-specific factors related to COVID-19, meaning the strength of evidence was only moderate, the strongest associations were observed for blood glucose levels greater than 11 mmol/l at admission and death, with an 8.6 times increased risk of death compared to <6 mmol/.

Using information from five studies, researchers suggest that patients using insulin to control their diabetes were 75% more likely to die with COVID-19 than non-insulin users. On the other hand, they point out that use of insulin usually indicates a more advanced course of diabetes. Metformin therapy appeared to have the opposite effect; the authors report that those using the drug, which is considered first-line therapy for type 2 diabetes, were 50% less likely to die with COVID-19 than those not using metformin, based on data from four studies.

The study notes high to moderate certainty of evidence for associations (SRR [95% CI]) between male sex (1.28 [1.02, 1.61], n = 10 studies), older age (>65 years: 3.49 [1.82, 6.69], n = 6 studies), pre-existing comorbidities (cardiovascular disease: 1.56 [1.09, 2.24], n = 8 studies; chronic kidney disease: 1.93 [1.28, 2.90], n = 6 studies; chronic obstructive pulmonary disease: 1.40 [1.21, 1.62], n = 5 studies), diabetes treatment (insulin use: 1.75 [1.01, 3.03], n = 5 studies; metformin use: 0.50 [0.28, 0.90], n = 4 studies) and blood glucose at admission (≥11 mmol/l: 8.60 [2.25, 32.83], n = 2 studies). Similar, but generally weaker and less precise associations were observed between risk phenotypes of diabetes and severity of COVID-19.

“Individuals with a more severe course of diabetes have a poorer prognosis of COVID-19 compared with individuals with a milder course of disease,” the authors conclude. “To further strengthen the evidence, more studies on this topic that account for potential confounders are warranted.”

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