Outcome and death risk of diabetes patients with Covid-19 receiving pre-hospital and in-hospital metformin therapies
Rodrigo Esaki Tamura, Said Muhammad Said, Leticia Mussin De Freitas, Ileana Gabriela Sanchez Rubio
Diabetology & Metabolic Syndrome, doi:10.1186/s13098-021-00695-8
Background: COVID-19 has stroke Brazil harshly, deaths by COVID-19 in Brazil represent almost 13% of the total deaths by COVID-19 in the world, even though Brazilian population represents only 2.6% of the world population. Our aim in this study was to evaluate death and intubation outcomes and risk factors associated with COVID-19, and treatment options focusing on diabetes patients and the use of metformin pre-admission and during hospitalization.
Methods: In this Brazilian single-center study we evaluated 1170 patients hospitalized due to COVID-19. Diabetes patients (n = 188) were divided based on their use of pre-hospital and in-hospital metformin (non-met-group and met-group). Results: In the total cohort most comorbidities were risk factors for orotracheal intubation and death. The use of chloroquine/hydroxychloroquine was significantly associated with increased death and intubation risk in uni-and multivariate analysis. Diabetes patients showed worst clinical feature compared with non-diabetes patients. In-hospital non-met-group had increased mortality (20.5%) compared to met-group (3.5%) (p = 0.0002) and univariable cox proportion hazard regression indicated in-hospital metformin reduced mortality (HR = 0.325, p = 0.035). Patients that used pre-hospital metformin showed lower severity parameters at hospital admission. (met-group: 2.45 ± 2.5; nonmet-group: 4.25 ± 3.4). In all the groups older patients showed more severe clinical conditions and high risk of death and intubation.
Conclusion: Even though this is a single-center study, results from other reports have shown a similar trend, indicating that patients that used metformin during hospitalization have a better prognosis and reduced risk of death.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s13098-021-00695-8. Additional file 1: Table S1 . Comparison of demographic and clinical characteristics of diabetes and non-diabetic patients. Table S2 . Clinical characteristics of diabetes' patients compared by age. Table S3 . Clinical characteristics of diabetes patients compared between dead and nondead patients. Table S4 . Univariate in-hospital risk factor associated with in-hospital mortality and orotracheal intubation of diabetes patients.
Authors' contributions RET designed and wrote the manuscript; SMS collected the data; LMF organized the data; IGSR designed, made the statistical analysis and revised the manuscript. All authors read and approved the final manuscript.
Declarations Ethics approval and consent to participate This study was approved by the Ethical Committee of the Santa Catarina Hospital and UNIFESP (CAAE 43014721.7.0000. 5505).
Consent for publication All authors consent the publication.
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