Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain

Abstract

Background Advanced age and diabetes are both associated with poor prognosis in COVID-19. However, the effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well-known. This work aims to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥ 80 years with type 2 diabetes mellitus hospitalized for COVID-19. Methods We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years with type 2 diabetes mellitus and COVID-19 hospitalized in 160 Spanish hospitals between March 1 and May 29, 2020 who were included in the SEMI-COVID-19 Registry. The primary outcome measure was in-hospital mortality. A multivariate logistic regression analysis were performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality. The regression analysis values were expressed as adjusted odds ratios (AOR) with a 95% confidence interval (CI). In order to select the variables, the forward selection Wald statistic was used. Discrimination of the fitted logistic model was assessed via a receiver operating characteristic (ROC) curve. The Hosmer-Lemeshow test for logistic regression was used to determine the model’s goodness of fit. Results Of the 2,763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of dipeptidyl peptidase-4 inhibitors (AOR 0.502, 95% CI 0.309–0.815, p = 0.005) and angiotensin receptor blockers (AOR 0.454, 95% CI 0.274–0.759, p = 0.003) were independent protectors against in-hospital mortality whereas the use of acetylsalicylic acid was associated with higher in-hospital mortality (AOR 1.761, 95% CI 1.092–2.842, p = 0.020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins showed neutral association with in-hospital mortality. The model showed an area under the curve of 0.788. Conclusions We found important differences between cardiometabolic drugs and in-hospital mortality in older patients with type 2 diabetes mellitus hospitalized for COVID-19. Preadmission treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers may reduce in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins seem to have a neutral effect; and acetylsalicylic acid may be associated with excess mortality.

Metformin therapy and severity and mortality of SARS-CoV-2 infection: a meta-analysis

“…The included studies were conducted in Austria [14], Belgium [15], China [16][17][18][19][20][21][22][23][24], France [25][26][27], Hong Kong [28], Iraq [29], Italy [30,31], Russia [32]which determines the high relevance of risk factor analysis for outcomes in DM patients to substantiate the strategy for this category of patients. AIM: To assess the effect of clinical and demographic parameters (age, gender, body mass index (BMI, South Korea [33,34], Spain [35,36], UK [37][38][39][40][41] and USA [42][43][44][45].…”

Is metformin use associated with low mortality in patients with type 2 diabetes mellitus hospitalized for COVID-19? a multivariable and propensity score-adjusted meta-analysis

“…After studies were carefully reviewed based on the inclusion and exclusion criteria, 22 retrospective observational studies were selected for further meta-analysis of metformin use and inhospital mortality. The flowchart for the study selection is shown in Fig 1 . Of these 22 studies, 17 studies reported on the association of outpatient metformin use and in-hospital mortality [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], 6 studies investigated the link between inpatient metformin use and in-hospital mortality [37][38][39][40][41][42], and 2 study probed the association of both outpatient and inpatient metformin PLOS ONE use and in-hospital mortality [37,42]. There were 16 studies with extractable raw event data.…”

Does Metformin Decrease Mortality in Patients with Type 2 Diabetes Mellitus Hospitalized for COVID-19? A Multivariable and Propensity Score-adjusted Meta-analysis

“…The flowchart for the study selection is shown in Figure 1. Of these 19 studies, 14 studies reported on the association of outpatient metformin use and in-hospital mortality [20][21][22][23][24][25][26][27][28][29][30][31][32][33], 4 studies investigated the link between inpatient metformin use and in-hospital mortality [34][35][36][37], and 1 study probed the association of both outpatient and inpatient metformin use and in-hospital mortality [38]. There were 13 studies with extractable raw event data.…”