This diabetes drug strongly lowers death risk in people with COVID-19 and diabetes

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In a new study, researchers found that the use of the diabetes drug metformin—before a diagnosis of COVID-19—is linked to a threefold decrease in mortality in COVID-19 patients with Type 2 diabetes.

This beneficial effect remained, even after correcting for age, sex, race, obesity, and hypertension or chronic kidney disease and heart failure.

Similar results have now been obtained in different populations from around the world—including China, France and a UnitedHealthcare analysis.

This suggests that the reduction in mortality risk linked to metformin use in people with Type 2 diabetes and COVID-19 might be generalizable.

The research was conducted by a team at the University of Alabama at Birmingham.

Diabetes is big comorbidity for COVID-19, and how metformin improves prognosis in the context of COVID-19 is not known.

The new findings suggest that the mechanisms may go beyond any expected improvement in glycemic control or obesity, since neither body mass index, blood glucose nor hemoglobin A1C was lower in the metformin users who survived as compared to those who died.

The mechanisms may involve metformin’s previously described anti-inflammatory and anti-thrombotic effects.

In the study, the team included 25,326 patients tested for COVID-19 at the tertiary care UAB Hospital between Feb. 25 and June 22 of last year.

Of the 604 patients found to be COVID-19-positive, 311 were African Americans.

The primary outcome in the study was mortality in COVID-19-positive patients.

The team found that the overall mortality for COVID-19-positive patients was 11%. About 93% of deaths occurred in people over the age of 50, and being male or having high blood pressure was linked to a much-elevated risk of death.

Diabetes was linked to a dramatic increase in mortality, with an odds ratio of 3.62. Overall, 67% of deaths in the study occurred in people with diabetes.

The researchers looked at the effects of diabetes treatment on adverse COVID-19 outcomes, focusing on insulin and metformin as the two most common medications for Type 2 diabetes.

They found that prior insulin use did not affect mortality risk.

However, prior metformin use was a different matter.

Metformin use strongly reduced the odds of dying, and the 11% mortality for metformin users was not only comparable to that of the general COVID-19-positive population, but it was also dramatically lower than the 23% mortality for diabetes patients not on metformin.

Interestingly, even after controlling for all these other covariates, death was much less likely for Type 2 diabetes patients taking metformin, compared with those who did not take metformin.

These results suggest that diabetes is an independent risk factor for COVID-19-related mortality.

But this risk is dramatically reduced in people taking metformin—raising the possibility that metformin may provide a protective approach in this high-risk population.”

One author of the study is Anath Shalev, M.D., the director of UAB’s Comprehensive Diabetes Center.

The study is published in Frontiers in Endocrinology.

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