Diabetes and COVID-19: analysis of the clinical outcomes according to the data of the russian diabetes registry

Abstract

Background: The data indicate a higher mortality rate in patients with diabetes mellitus (DM) due to COVID-19, which determines the high relevance for study of risk factors for outcomes.
 Aim: to assess the effect of clinical and demographic parameters (age, gender, body mass index (BMI), glycemic control (HbA1c), antidiabetic and antihypertensive drugs, including ACE inhibitors and ARB) on clinical outcomes (recovery or death) in patients with T2DM.
 Materials and methods: A retrospective analysis of the Russian Diabetes Register database, included T2DM patients (n=309) with pneumonia/COVID-19 since 01.02.2020 to 04.27.2020 and known outcome (recovery/death )
 Results: Lethality was 15.2% (47/309). Lethality was found to be significantly higher in males (OR=2.08; 95% CI 1.1-3.9; p=0.02) and in patients on insulin therapy (OR = 2.67; 95% CI; 1.42-5.02; p=0.02). Lethality was significantly lower at the age of 65 years (OR= 0.34; 95% CI 0.18-0.67; p = 0.01), in patients receiving metformin (OR=0.26; 95% CI 0.14-0 , 5; p 0.0001), antihypertensive therapy (OR=0.43; 95% CI 0.22-0.82; p=0.009), beta-blockers (OR = 0.26; 95% CI 0.08-0.86; p = 0.018), diuretics (OR=0.4; 95% CI 0.17-0.93; p=0.028) and blockers of the renin-angiotensin system (ACE inhibitors or ARB) (OR=0.36; 95% CI 0.18-0.74; p=0.004). There was a tendency to an increase in lethality at higher rates of HbA1c and BMI, but not reaching statistical significance. Patients on insulin had longer DM duration (13.4 versus 6.8 years, p 0.0001), worse HbA1c (8.1% versus 7.0%, p0.0001) and 3 times more patients with HbA1c 2.5% above goal (14.7% versus 5.9%, p=0.04).
 Conclusion: Higher lethality on insulin therapy was due to worse glycemic control in this group of patients.The identified risk factors for lethality in patients with type 2 DM indicate that good glycemic control, previous treatment with metformin and antihypertensive drugs (including RAS blockers) could reduce the mortality risks.

The Association Between Hypoglycemic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

“…Sensitivity analysis did not identify any specific original study that led to unstable results, which might be explained by the discrepancy of included studies themselves. Gender ratio and average age accounted for a portion of unstable results as female and young patients(30, 34) reportedly have a better prognosis. Elements including duration of medication (from <21 day(25) to >6 months), dose, common drugs in exposure and control groups(29), long-term blood glucose control (HbA1c)(34, 57), BMI(26) and comorbidities(58) varied in different studies and were likely related to heterogeneity.…”

“…Gender ratio and average age accounted for a portion of unstable results as female and young patients(30, 34) reportedly have a better prognosis. Elements including duration of medication (from <21 day(25) to >6 months), dose, common drugs in exposure and control groups(29), long-term blood glucose control (HbA1c)(34, 57), BMI(26) and comorbidities(58) varied in different studies and were likely related to heterogeneity. We also calculated the prediction interval (PI) to reflect the variation in treatment effects over different settings, predict the expected effect on future patients as a supplement to CI(24) and 95% CI of I 2 described the proportion of total variation in study estimates that is due to heterogeneity (59).…”

“…preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted January 27, 2021. ; https://doi.org/10.1101/2021.01.26.21250506 doi: medRxiv preprint 16 studies were included in qualitative synthesis. Among these, 12 studies related to metformin (15,16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), 6 studies related to DPP-4i (27,28,33,(35)(36)(37)(38), 3 studies related to sulfonylurea or glinides (27,28,33,35), 2 studies related to SGLT-2i (33,35) and 1 study related to GLP-1RA (27,28). Some of these studies included multiple outcomes to different medications.…”

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

“…Out of 946 potentially relevant articles, and following application of inclusion criteria, 32 studies were retained including a total of 44306 participants. 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].…”

Outcome and death risk of diabetes patients with Covid-19 receiving pre-hospital and in-hospital metformin therapies

“…Afterwards it had been suggested for the FDA to change metformin on-label use as adjuvant therapy against COVID-19 in obese, elderly and diabetes patients [ 11 ]. Different reports indicated a positive correlation of survival with use of metformin prior to admission [ 12 – 17 ], or during hospitalization [ 18 – 22 ], while others have not observed any correlation with time of hospitalization, severity or death by COVID-19 patients that used metformin in admission [ 23 , 24 ].…”