Association of Metformin with Susceptibility to COVID-19 in People with Type 2 Diabetes

Abstract Objective Diabetes has emerged as an important risk factor for mortality from COVID-19. Metformin, the most commonly prescribed glucose-lowering agent, has been proposed to influence susceptibility to and outcomes of COVID-19 via multiple mechanisms. We investigated whether, in patients with diabetes, metformin is associated with susceptibility to COVID-19 and its outcomes. Research Design and Methods We performed a propensity score–matched cohort study with active comparators using a large UK primary care dataset. Adults with type 2 diabetes patients and a current prescription for metformin and other glucose-lowering agents (MF+) were compared to those with a current prescription for glucose-lowering agents that did not include metformin (MF−). Outcomes were confirmed COVID-19, suspected/confirmed COVID-19, and associated mortality. A negative control outcome analysis (back pain) was also performed. Results There were 29 558 and 10 271 patients in the MF+ and MF− groups, respectively, who met the inclusion criteria. In the propensity score–matched analysis, the adjusted hazard ratios for suspected/confirmed COVID-19, confirmed COVID-19, and COVID-19-related mortality were 0.85 (95% CI 0.67, 1.08), 0.80 (95% CI 0.49, 1.30), and 0.87 (95% CI 0.34, 2.20) respectively. The negative outcome control analysis did not suggest unobserved confounding. Conclusion Current prescription of metformin was not associated with the risk of COVID-19 or COVID-19-related mortality. It is safe to continue prescribing metformin to improve glycemic control in patients with.

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Glucose-lowering therapies in patients with type 2 diabetes and cardiovascular diseases

European Journal of Preventive Cardiology ◽

10.1177/2047487319880040 ◽

2019 ◽

Vol 26 (2_suppl) ◽

pp. 73-80 ◽

Cited By ~ 18

Author(s):

Francesco Prattichizzo ◽

Lucia La Sala ◽

Lars Rydén ◽

Nikolaus Marx ◽

Marc Ferrini ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Receptor Agonist ◽

Glucose Lowering ◽

Patients With Diabetes ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

Type 2 diabetes mellitus is a major risk factor for developing cardiovascular disease, and many patients with diabetes have prevalent cardiovascular complications. Recent cardiovascular outcome clinical trials suggest that certain new glucose-lowering drugs are accompanied by additional cardioprotective properties. Indeed, selected glucagon-like peptide-1 receptor agonists have a proved cardiovascular benefit in terms of a reduced incidence of ischaemic events, while sodium/glucose co-transporter-2 inhibitors have also shown significant protection, with a striking effect on heart failure and renal endpoints. These findings have been integrated in recent guidelines which now recommend prescribing (when initial metformin monotherapy fails) a glucagon-like peptide-1 receptor agonist or a sodium/glucose co-transporter-2 inhibitor with clinical trial-confirmed benefit in patients with diabetes and atherosclerotic cardiovascular disease, and a sodium/glucose co-transporter-2 inhibitor in such patients with heart failure or chronic kidney disease at initial stages. Furthermore, the new 2019 European Society of Cardiology guidelines in collaboration with the European Association for the Study of Diabetes recommend a glucagon-like peptide-1 receptor agonist or a sodium/glucose co-transporter-2 inhibitor in treatment-naive patients with type 2 diabetes mellitus with pre-existing cardiovascular disease or at high cardiovascular risk. Future research will disentangle the mechanisms underpinning these beneficial effects and will also establish to what extent these results are generalisable to the whole diabetes population. In the meantime, available evidence should prompt a wide diffusion of these two classes of drugs among patients with diabetes and cardiovascular disease. Here, we briefly summarise recent findings emerging from cardiovascular outcome clinical trials, discuss their impact on treatment algorithms and propose new possible approaches to improve our knowledge further regarding the cardiovascular effect of glucose-lowering medications.

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Intensification of glucose-lowering treatment in patients with diabetes mellitus type 2 on insulin therapy: Perspectives of dapagliflozin

Diabetes Mellitus ◽

10.14341/dm7745 ◽

2016 ◽

Vol 19 (1) ◽

pp. 72-79

Author(s):

Olga Yuryevna Sukhareva ◽

Marina Vladimirovna Shestakova

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Clinical Trials ◽

Type 2 Diabetes Mellitus ◽

Insulin Therapy ◽

Diabetes Mellitus Type 2 ◽

Glucose Lowering ◽

Patients With Diabetes ◽

Difficult Issue

Intensification of antihyperglycaemic treatment in patients with poorly controlled type 2 diabetes mellitus who were on insulin therapy remains a difficult issue. Results from clinical trials with the sodium-glucose linked transporter (SGLT-2) inhibitor dapagliflozin as add-on therapy in patients with type 2 diabetes mellitus using insulin are summarised and discussed in the article.

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Association Between Preadmission Metformin Use and Outcomes in Intensive Care Unit Patients With Sepsis and Type 2 Diabetes: A Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.640785 ◽

2021 ◽

Vol 8 ◽

Author(s):

Qilin Yang ◽

Jiezhao Zheng ◽

Weiyan Chen ◽

Xiaohua Chen ◽

Deliang Wen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Intensive Care ◽

Medical Information ◽

Cox Regression ◽

Sensitivity Analyses ◽

Regression Analyses ◽

Patients With Diabetes ◽

Reduced Risk ◽

Related Mortality

Background: Sepsis is a deadly disease worldwide. Effective treatment strategy of sepsis remains limited. There still was a controversial about association between preadmission metformin use and mortality in sepsis patients with diabetes. We aimed to assess sepsis-related mortality in patients with type 2 diabetes (T2DM) who were preadmission metformin and non-metformin users.Methods: The patients with sepsis and T2DM were included from Medical Information Mart for Intensive Care -III database. Outcome was 30-day mortality. We used multivariable Cox regression analyses to calculate adjusted hazard ratio (HR) with 95% CI.Results: We included 2,383 sepsis patients with T2DM (476 and 1,907 patients were preadmission metformin and non-metformin uses) between 2001 and 2012. The overall 30-day mortality was 20.1% (480/2,383); it was 21.9% (418/1,907), and 13.0% (62/476) for non-metformin and metformin users, respectively. After adjusted for potential confounders, we found that preadmission metformin use was associated with 39% lower of 30-day mortality (HR = 0.61, 95% CI: 0.46–0.81, p = 0.007). In sensitivity analyses, subgroups analyses, and propensity score matching, the results remain stable.Conclusions: Preadmission metformin use may be associated with reduced risk-adjusted mortality in patients with sepsis and T2DM. It is worthy to further investigate this association.

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PRIORITIES OF ANTI-HYPERGLYCAEMIC DRUG THERAPY IN PATIENTS WITH TYPE 2 DIABETES AND HEART FAILURE

Wiadomości Lekarskie ◽

10.36740/wlek202003139 ◽

2020 ◽

Vol 73 (3) ◽

pp. 609-613

Author(s):

Мaryana М. Rоsul ◽

Мiroslava М. Bletskan ◽

Nataliya V. Ivano ◽

Marina O. Korabelschykova ◽

Yelyzaveta І. Rubtsova

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Large Scale ◽

Cardiovascular Complications ◽

Glucose Lowering ◽

Wall Stiffness ◽

Patients With Heart Failure ◽

Patients With Diabetes

The aim is to explore the possibilities of improving the effectiveness in preventing cardiovascular diseases and heart failure using sodium-glucose co-transporter 2 inhibitors. Materials and methods: The analysis of the existing clinical and experimental data on the effect of sodium-glucose co-transporter 2 (SGLT-2) inhibitors on the cardiovascular system, the condition of kidneys, cardiovascular risk factors. Review: SGLT-2 inhibitors are the first class of glucose-lowering agents in large-scale studies (EMPA-REG OUTCOME, CANVAS, CVD-REAL, CVD-REAL2) which have demonstrated the ability to improve cardiorenal outcomes and reduce the risk of hospitalization with heart failure in patients with diabetes. In addition to hypoglycaemic action, SGLT-2 inhibitors show a number of pleiotropic effects, which are potentially capable of reducing cardiovascular risk: diuretic effect, decrease in: blood pressure, arterial wall stiffness, waist and body weight, expression of albuminuria, etc. The use of drugs of this class opens great prospects not only in terms of glycaemic control, but also in the prevention of cardiovascular complications of diabetes. Conclusions: 1. When choosing glucose-lowering agents in patients with type 2 diabetes, it is necessary to take into account their impact on the risk of development and the course of heart failure. 2. SGLT-2 inhibitors ought to be considered as a preferred method of treatment for type 2 diabetes in patients with heart failure or with a risk of heart failure that meets the latest recommendations of the European and American Diabetes Association.

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COVID-19 outcomes in people with diabetes in Wales: a secondary analysis of the ABCD audit

British Journal of Diabetes ◽

10.15277/bjd.2021.319 ◽

2021 ◽

Author(s):

David M Williams ◽

Jim Davies ◽

Benjamin CT Field ◽

Rajiv Gandhi ◽

Sophie Harris ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Secondary Analysis ◽

Risk Of Death ◽

Retrospective Audit ◽

Hospitalised Patients ◽

Patients With Diabetes ◽

The Uk ◽

Related Mortality

Background: People with diabetes and coronavirus disease 2019 (COVID-19) have a significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19. Methods: The ABCD COVID-19 and diabetes audit was a retrospective audit of patients admitted to UK hospitals with diabetes and COVID-19 between March and December 2020. Data related to patients admitted in Wales were compared with patients admitted in England and Scotland. Results: In Wales, 40/82 (48.7%) patients with diabetes had COVID-19-related mortality compared with 1,149/2,916 (39.1%) in the UK group (p=0.08). The Welsh cohort were more likely to be Caucasian, have a higher body mass index and HbA1c, be diagnosed with diabetic retinopathy and prescribed a sodium-glucose co-transporter 2 inhibitor or insulin than those in England and Scotland. Patients admitted to the ICU in Wales were more likely to be male and have type 2 diabetes. Conclusions: Patients admitted to hospital with diabetes and COVID-19 in Wales had a poorer outcome compared with England and Scotland. This disparity may reflect social inequality, differences in cardiovascular risk factors and/or differences in diabetes medications between hospitalised patients in Wales and the UK.

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The Influence of Type 2 Diabetes and Glucose-Lowering Therapies on Cancer Risk in the Taiwanese

Experimental Diabetes Research ◽

10.1155/2012/413782 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 87

Author(s):

Ming-Chia Hsieh ◽

Tzu-Chi Lee ◽

Shu-Min Cheng ◽

Shih-Te Tu ◽

Ming-Hong Yen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Cancer ◽

Cancer Risk ◽

Insulin Treatment ◽

Diabetic Patients ◽

Glucose Lowering ◽

Research Institutes ◽

Increased Risk ◽

Patients With Diabetes

Objective. To investigate the association between type 2 diabetes, glucose-lowering therapies (monotherapy with either metformin, sulphonylurea or insulin) and cancer risk in Taiwan.Methods. Using Taiwan’s National Health Research Institutes database of 1,000,000 random subjects from 2000–2008, we found 61777 patients with type 2 diabetes (age ≥20 years) and 677378 enrollees with no record of diabetes.Results. After adjusting for age and sex, we found patients with diabetes to have significantly higher risk of all cancers (OR: 1.176; 95% CI: 1.149–1.204,P<0.001). Diabetic patients treated with insulin or sulfonylureas had significantly higher risk of all cancers, compared to those treated with metformin (OR: 1.583; 95% CI: 1.389–1.805,P<0.001and OR: 1.784; 95% CI: 1.406–2.262,P<0.001). Metformin treatment was associated with a decreased risk of colon and liver cancer compared to sulphonylureas or insulin treatment. Sulfonylureas treatment was associated with an increased risk of breast and lung cancer compared to metformin therapy.Conclusions. Taiwanese with type 2 diabetes are at a high risk of breast, prostate, colon, lung, liver and pancreatic cancer. Those treated with insulin or sulfonylureas monotherapy are more likely to develop colon and liver cancer than those treated with metformin.

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Perioperative Management of Oral Glucose-lowering Drugs in the Patient with Type 2 Diabetes

Anesthesiology ◽

10.1097/aln.0000000000003237 ◽

2020 ◽

Vol 133 (2) ◽

pp. 430-438 ◽

Cited By ~ 4

Author(s):

Jean-Charles Preiser ◽

Bruna Provenzano ◽

Wasineeart Mongkolpun ◽

Katarina Halenarova ◽

Miriam Cnop

Keyword(s):

Type 2 Diabetes ◽

Chronic Treatment ◽

Perioperative Management ◽

Oral Glucose ◽

Glucose Lowering ◽

Patients With Diabetes ◽

The Right

The right management of oral glucose-lowering drugs aims to identify, assess, and follow patients with diabetes and avoid unnecessary interruptions of the chronic treatment.

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Hypoglycemia and the risk of cognitive impairment and dementia in elderly and senile patients with type 2 diabetes

Diabetes Mellitus ◽

10.14341/dm10202 ◽

2020 ◽

Vol 23 (1) ◽

pp. 72-87

Author(s):

Olga D. Ostroumova ◽

Elena V. Surkova ◽

Irina V. Goloborodova ◽

Antonina V. Starodubova ◽

Alexey I. Kochetkov ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Cognitive Impairment ◽

Age Groups ◽

Cognitive Status ◽

Antidiabetic Drugs ◽

Diabetic Patients ◽

Glucose Lowering ◽

Patients With Diabetes

Research results show that poor glycemic control and recurrent episodes of severe hypoglycaemia are associated with a decrease in cognitive function in elderly people with type 2 diabetes mellitus (T2DM). On the other hand, patients with diabetes mellitus associated with cognitive impairment/dementia are most at risk of developing hypoglycaemic conditions. It is obvious that the relationship between hypoglycaemia and dementia is very complex and has a mutually aggravating nature. Studies also show that individuals of older age groups with diabetes and cognitive impairment have a high risk of developing hypoglycaemic conditions, such as unwanted side effects from glucose-lowering therapy. In this case, of particular interest is the question that is being actively studied at the present time, which is concerning the effect of different groups of glucose-lowering antidiabetic drugs on the cognitive status and the rate of cognitive decline in diabetic patients with cognitive impairment. In this review, we attempted to summarise, systematise, and present data available in the literature concerning the effect of hypoglycaemia on the risk of cognitive impairment and dementia in elderly and senile patients with type-2 diabetes, as well as the degree of participation in this process of of various groups of sugar-lowering antidiabetic drugs.

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