Risk of Metformin in Patients With Type 2 Diabetes With COVID‐19: A Preliminary Retrospective Report
Yongchao Gao, Tao Liu, Weijun Zhong, Rong Liu, Honghao Zhou, Weihua Huang, Wei Zhang
Clinical and Translational Science, doi:10.1111/cts.12897
The current outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread across the world. No specific antiviral agents have been adequately evidenced for the treatment of coronavirus disease 2019 (COVID-19). Although metformin has been recommended as a host-directed therapy for COVID-19, there are some opposite views. The effects of metformin on the disease severity of patients with COVID-19 with diabetes during hospitalization remains unclear. This study aimed to determine the effect of metformin on disease severity. We enrolled 110 hospitalized patients with COVID-19 with diabetes prescribed either metformin or non-metformin hypoglycemic treatment for a case-control study. The primary outcome was the occurrence of life-threatening complications. There were no differences between the two groups in age, sex, comorbidities, and clinical severity at admission. Blood glucose and lactate dehydrogenase levels of the metformin group were higher than those of the non-metformin group at admission. Other laboratory parameters at admission and treatments after admission were not different between the two groups. Strikingly, the percentage of patients who experienced life-threatening complications was significantly higher in the metformin group (28.6% (16/56) vs. 7.4% (4/54), P = 0.004). Antidiabetic therapy with metformin was associated with a higher risk of disease progression in patients with COVID-19 with diabetes during hospitalization (adjusted odds ratio = 3.964, 95% confidence interval 1.034-15.194, P = 0.045). This retrospective analysis suggested a potential safety signal for metformin, the use of which was associated with a higher risk of severe COVID-19. We propose that metformin withdrawal in patients with COVID-19 be considered to prevent disease progression. The current outbreak of coronavirus disease 2019 (COVID-19) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread quickly through human-to-human transmission, 1 and has been declared as "Public Health Emergency of International Concern" by the World Health Organization (WHO). As both SARS-CoV 2 and Middle East respiratory syndrome coronavirus (MERS-CoV), 3 the SARS-CoV-2 outbreak has caused a large number of human deaths
Conflict of Interest. All other authors declared no competing interests for this work.
References
Chen, Clinical characteristics and outcomes of patients with diabetes and COVID-19 in association with glucose-lowering medication, Diabetes Care,
doi:10.2337/dc20-0660Hui, Zumla, Severe acute respiratory syndrome: historical, epidemiologic, and clinical features, Infect. Dis. Clin. North Am,
doi:10.1016/j.idc.2019.07.001Katulanda, Prevention and management of COVID-19 among patients with diabetes: an appraisal of the literature, Diabetologia,
doi:10.1007/s00125-020-05164-xLi, Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia, N. Engl. J. Med,
doi:10.1056/NEJMoa2001316Roncon, Zuin, Rigatelli, Zuliani, Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome, J. Clin. Virol,
doi:10.1016/j.jcv.2020.104354Shi, Clinical characteristics and risk factors for mortality of COVID-19 patients with diabetes in Wuhan, China: a two-center, retrospective study, Diabetes Care,
doi:10.2337/dc20-0598Wang, O-GlcNAc transferase promotes influenza A virus-induced cytokine storm by targeting interferon regulatory factor-5, Sci. Adv,
doi:10.1126/sciadv.aaz7086Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention, JAMA,
doi:10.1001/jama.2020.2648Zhang, AMP-activated protein kinase phosphorylation of angiotensin-converting enzyme 2 in endothelium mitigates pulmonary hypertension, Am. J. Respir. Crit. Care Med,
doi:10.1164/rccm.201712-2570OCZhao, Analysis of the susceptibility to COVID-19 in pregnancy and recommendations on potential drug screening, Eur. J. Clin. Microbiol. Infect. Dis,
doi:10.1007/s10096-020-03897-6Zhou, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3Zhu, Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes, Cell Metab,
doi:10.1016/j.cmet.2020.04.021
