Patients with type 2 diabetes mellitus (T2DM) are at
increased risk of severe COVID-19 outcomes possibly due to dysregulated
inflammatory responses. Glucose-regulating medications such as glucagon-like
peptide-1 receptor (GLP-1R) agonists, dipeptidyl peptidase-4 (DPP-4)
inhibitors, and pioglitazone are known
to have anti-inflammatory effects that may improve outcomes in patients with
SARS-CoV-2 infection. In a multinational retrospective cohort study, we used
the TriNetX COVID-19 Research Network of 56 large healthcare organizations to
examine these medications in relation to the incidence of hospital admissions,
respiratory complications, and mortality within 28 days following a COVID-19 diagnosis.
After matching for age, sex, race, ethnicity, body mass index, and significant
comorbidities, use of GLP-1R agonists and/or pioglitazone was associated with
significant reductions in hospital admissions (GLP-1R: 15.7% vs 23.5%; RR, 0.67
[95% CI, 0.57-0.79]; <i>P</i> <.001; pioglitazone: 20.0% vs 28.2%; RR, 0.71
[95% CI, 0.54-0.93]; <i>P</i> =.01). Use of GLP-1R agonists was also associated
with reductions in respiratory complications (15.3% vs 24.9%; RR, 0.62 [95% CI,
0.52-0.73]; <i>P</i> <.001) and incidence of mortality (1.9% vs 3.3%; RR, 0.58
[95% CI, 0.35-0.97]; <i>P</i> =.04). Use of DPP-4 inhibitors was associated
with a reduction in respiratory complications (24.0% vs 29.2%; RR, 0.82 [95%
CI, 0.74-0.90]; <i>P</i> <.001), and continued use of DPP-4 inhibitors after
hospitalization was associated with a decrease in mortality compared with those
who discontinued use (9% vs 19%; RR, 0.45 [95% CI, 0.28-0.72]; <i>P</i>
<.001). In conclusion, use of glucose-regulating medications such as
GLP-1R agonists, DPP-4 inhibitors, or pioglitazone may improve outcomes for COVID-19 patients with T2DM; randomized clinical
trials are needed to further investigate this possibility.
Determinants of type 2 diabetes remission after bariatric surgery in obese Japanese patients: a retrospective cohort study
