Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes.
Aged
COVID-19
/ mortality
Diabetes Mellitus
/ drug therapy
Ethnicity
/ statistics & numerical data
Female
Follow-Up Studies
Hospital Mortality
/ trends
Hospitalization
/ statistics & numerical data
Humans
Hypoglycemic Agents
/ therapeutic use
Male
Metformin
/ therapeutic use
Middle Aged
Prognosis
Retrospective Studies
SARS-CoV-2
/ drug effects
Survival Rate
United States
/ epidemiology
COVID-19 Drug Treatment
African-American
coronavirus disease-2019
diabetes
metformin
mortality
Journal
Frontiers in endocrinology
ISSN: 1664-2392
Titre abrégé: Front Endocrinol (Lausanne)
Pays: Switzerland
ID NLM: 101555782
Informations de publication
Date de publication:
2020
2020
Historique:
received:
30
08
2020
accepted:
07
12
2020
entrez:
1
2
2021
pubmed:
2
2
2021
medline:
16
2
2021
Statut:
epublish
Résumé
Coronavirus disease-2019 (COVID-19) is a growing pandemic with an increasing death toll that has been linked to various comorbidities as well as racial disparity. However, the specific characteristics of these at-risk populations are still not known and approaches to lower mortality are lacking. We conducted a retrospective electronic health record data analysis of 25,326 subjects tested for COVID-19 between 2/25/20 and 6/22/20 at the University of Alabama at Birmingham Hospital, a tertiary health care center in the racially diverse Southern U.S. The primary outcome was mortality in COVID-19-positive subjects and the association with subject characteristics and comorbidities was analyzed using simple and multiple linear logistic regression. The odds ratio of contracting COVID-19 was disproportionately high in Blacks/African-Americans (OR 2.6; 95% CI 2.19-3.10; p<0.0001) and in subjects with obesity (OR 1.93; 95% CI 1.64-2.28; p<0.0001), hypertension (OR 2.46; 95% CI 2.07-2.93; p<0.0001), and diabetes (OR 2.11; 95% CI 1.78-2.48; p<0.0001). Diabetes was also associated with a dramatic increase in mortality (OR 3.62; 95% CI 2.11-6.2; p<0.0001) and emerged as an independent risk factor in this diverse population even after correcting for age, race, sex, obesity, and hypertension. Interestingly, we found that metformin treatment prior to diagnosis of COVID-19 was independently associated with a significant reduction in mortality in subjects with diabetes and COVID-19 (OR 0.33; 95% CI 0.13-0.84; p=0.0210). Thus, these results suggest that while diabetes is an independent risk factor for COVID-19-related mortality, this risk is dramatically reduced in subjects taking metformin prior to diagnosis of COVID-19, raising the possibility that metformin may provide a protective approach in this high risk population.
Sections du résumé
Background
Coronavirus disease-2019 (COVID-19) is a growing pandemic with an increasing death toll that has been linked to various comorbidities as well as racial disparity. However, the specific characteristics of these at-risk populations are still not known and approaches to lower mortality are lacking.
Methods
We conducted a retrospective electronic health record data analysis of 25,326 subjects tested for COVID-19 between 2/25/20 and 6/22/20 at the University of Alabama at Birmingham Hospital, a tertiary health care center in the racially diverse Southern U.S. The primary outcome was mortality in COVID-19-positive subjects and the association with subject characteristics and comorbidities was analyzed using simple and multiple linear logistic regression.
Results
The odds ratio of contracting COVID-19 was disproportionately high in Blacks/African-Americans (OR 2.6; 95% CI 2.19-3.10; p<0.0001) and in subjects with obesity (OR 1.93; 95% CI 1.64-2.28; p<0.0001), hypertension (OR 2.46; 95% CI 2.07-2.93; p<0.0001), and diabetes (OR 2.11; 95% CI 1.78-2.48; p<0.0001). Diabetes was also associated with a dramatic increase in mortality (OR 3.62; 95% CI 2.11-6.2; p<0.0001) and emerged as an independent risk factor in this diverse population even after correcting for age, race, sex, obesity, and hypertension. Interestingly, we found that metformin treatment prior to diagnosis of COVID-19 was independently associated with a significant reduction in mortality in subjects with diabetes and COVID-19 (OR 0.33; 95% CI 0.13-0.84; p=0.0210).
Conclusion
Thus, these results suggest that while diabetes is an independent risk factor for COVID-19-related mortality, this risk is dramatically reduced in subjects taking metformin prior to diagnosis of COVID-19, raising the possibility that metformin may provide a protective approach in this high risk population.
Identifiants
pubmed: 33519709
doi: 10.3389/fendo.2020.600439
pmc: PMC7838490
doi:
Substances chimiques
Hypoglycemic Agents
0
Metformin
9100L32L2N
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
600439Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK079626
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK078752
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK120379
Pays : United States
Commentaires et corrections
Type : UpdateOf
Informations de copyright
Copyright © 2021 Crouse, Grimes, Li, Might, Ovalle and Shalev.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
N Engl J Med. 2020 Jun 25;382(26):2534-2543
pubmed: 32459916
Diabetes. 2020 Sep;69(9):1857-1863
pubmed: 32669390
Infection. 2020 Aug;48(4):543-551
pubmed: 32342479
Int J Environ Res Public Health. 2020 Jun 17;17(12):
pubmed: 32560363
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
Br J Pharmacol. 2011 Apr;162(7):1498-508
pubmed: 21091653
Diabetes Care. 2020 Jul;43(7):1392-1398
pubmed: 32409502
Nat Rev Immunol. 2016 Oct;16(10):626-38
pubmed: 27546235
Front Endocrinol (Lausanne). 2021 Jan 13;11:600439
pubmed: 33519709
Crit Care. 2013 Sep 09;17(5):R192
pubmed: 24018017
Lancet Diabetes Endocrinol. 2020 Sep;8(9):782-792
pubmed: 32687793
Diabetologia. 2020 Aug;63(8):1500-1515
pubmed: 32472191
Diabete Metab. 1991 May;17(1 Pt 2):168-73
pubmed: 1936471
Diabetes Metab. 2020 Sep;46(4):265-271
pubmed: 32447101
Curr Diabetes Rev. 2010 Jan;6(1):27-34
pubmed: 20034371
Cell Metab. 2020 Jun 2;31(6):1068-1077.e3
pubmed: 32369736
JAMA. 2020 May 26;323(20):2052-2059
pubmed: 32320003
Metabolism. 2020 Jul;108:154262
pubmed: 32422233
Diabetologia. 2019 Oct;62(10):1751-1760
pubmed: 31451876
Am J Trop Med Hyg. 2020 Jul;103(1):69-72
pubmed: 32446312
Clin Infect Dis. 2021 Feb 16;72(4):703-706
pubmed: 32562416
Circ Res. 2020 Jul 31;127(4):571-587
pubmed: 32586214
Obes Med. 2020 Sep;19:100290
pubmed: 32844132
Diabetes Obes Metab. 2020 Oct;22(10):1935-1941
pubmed: 32314455
Blood. 2020 Jun 4;135(23):2033-2040
pubmed: 32339221
Cell Stem Cell. 2020 Jul 2;27(1):125-136.e7
pubmed: 32579880
Endocrinol Metab Clin North Am. 2016 Dec;45(4):819-843
pubmed: 27823607
J Vasc Surg. 2020 Sep;72(3):799-804
pubmed: 32417304
BMJ Open. 2017 Jan 25;7(1):e013894
pubmed: 28122835
Circ Res. 2016 Aug 19;119(5):652-65
pubmed: 27418629
Sci Rep. 2016 Nov 02;6:36222
pubmed: 27805009