Association of metformin with mortality or ARDS in patients with COVID-19 and type 2 diabetes: A retrospective cohort study

https://doi.org/10.1016/j.diabres.2020.108619Get rights and content

Abstract

Aims

To determine the association between metformin use and mortality and ARDS incidence in patients with COVID-19 and type 2 diabetes.

Methods

This study was a multi-center retrospective analysis of COVID-19 patients with type 2 diabetes and admitted to four hospitals in Hubei province, China from December 31st, 2019 to March 31st, 2020. Patients were divided into two groups according to their exposure to metformin during hospitalization. The outcomes of interest were 30-day all-cause mortality and incidence of ARDS. We used mixed-effect Cox model and random effect logistic regression to evaluate the associations of metformin use with outcomes, adjusted for baseline characteristics.

Results

Of 328 patients with COVID-19 and type 2 diabetes included in the study cohort, 30.5% (100/328) were in the metformin group. In the mixed-effected model, metformin use was associated with the lower incidence of ARDS. There was no significant association between metformin use and 30-day all-cause mortality. Propensity score-matched analysis confirmed the results. In the subgroup analysis, metformin use was associated with the lower incidence of ARDS in females.

Conclusions

Metformin may have potential benefits in reducing the incidence of ARDS in patients with COVID-19 and type 2 diabetes. However, this benefit differs significantly by gender.

Keywords

COVID-19
Metformin
Mortality
Diabetes mellitus

Abbreviations

COVID-19
Coronavirus disease 2019
SARS-CoV-2
Severe Acute Respiratory Syndrome Coronavirus 2
ARDS
acute respiratory distress syndrome
AMPK
AMP-activated protein kinase
RR
respiratory rate
SpO2
pulse oxygen saturation
CHD
coronary heart disease
FBG
fasting blood glucose
HbA1c
hemoglobin A1c
DDI
D-dimer
CRP
C-reaction protein
LDH
lactic dehydrogenase
AST
aspartate aminotransferase
ALT
alanine aminotransferase
IQR
inter-quartile range
MICE
Multivariate Imputation Using Chained Equations
NF-kB
nuclear factor-kB
mTORC1
mechanistic target of rapamycin complex 1
TNF-α
tumor necrosis factor-alpha
DIO
diet induced obesity
IL-10
interleukin-10

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1

These authors contributed equally to this work.

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