Effect of Antidiabetic Therapy on Clinical Outcomes of COVID-19 Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

Zhan, Kegang; Weng, Liuqi; Li, Qi; Wang, Luhan; Lin, Hao; Fang, Xiaoyu; Jia, Hong; Ma, Xiangyu

doi:10.1177/10600280221133577

Cited by 6 publications

(1 citation statement)

References 119 publications

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“…GLP-1RA and SGLT2i inhibitors have garnered particular attention due to their anti-inflammatory effects and well-established cardiovascular risk reduction in high-risk individuals [ 14 , 15 ]. We and others have demonstrated an association between the use of GLP-1RA and SGLT-2i and reduced adverse outcomes of COVID-19 [ 6 , 16 – 22 ]. Whether this association remained as the pandemic progressed, with novel variants and increasing natural and vaccine-induced immunity, has not been established.…”

Section: Discussionmentioning

confidence: 99%

Association of Premorbid GLP-1RA and SGLT-2i Prescription Alone and in Combination with COVID-19 Severity

Klein,

Abrahamsen,

Kahkoska

et al. 2024

Diabetes Ther

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Introduction People with type 2 diabetes are at heightened risk for severe outcomes related to COVID-19 infection, including hospitalization, intensive care unit admission, and mortality. This study was designed to examine the impact of premorbid use of glucagon-like peptide-1 receptor agonist (GLP-1RA) monotherapy, sodium-glucose cotransporter-2 inhibitor (SGLT-2i) monotherapy, and concomitant GLP1-RA/SGLT-2i therapy on the severity of outcomes in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Utilizing observational data from the National COVID Cohort Collaborative through September 2022, we compared outcomes in 78,806 individuals with a prescription of GLP-1RA and SGLT-2i versus a prescription of dipeptidyl peptidase 4 inhibitors (DPP-4i) within 24 months of a positive SARS-CoV-2 PCR test. We also compared concomitant GLP-1RA/SGLT-2i therapy to GLP-1RA and SGLT-2i monotherapy. The primary outcome was 60-day mortality, measured from the positive test date. Secondary outcomes included emergency room (ER) visits, hospitalization, and mechanical ventilation within 14 days. Using a super learner approach and accounting for baseline characteristics, associations were quantified with odds ratios (OR) estimated with targeted maximum likelihood estimation (TMLE). Results Use of GLP-1RA (OR 0.64, 95% confidence interval [CI] 0.56–0.72) and SGLT-2i (OR 0.62, 95% CI 0.57–0.68) were associated with lower odds of 60-day mortality compared to DPP-4i use. Additionally, the OR of ER visits and hospitalizations were similarly reduced with GLP1-RA and SGLT-2i use. Concomitant GLP-1RA/SGLT-2i use showed similar odds of 60-day mortality when compared to GLP-1RA or SGLT-2i use alone (OR 0.92, 95% CI 0.81–1.05 and OR 0.88, 95% CI 0.76–1.01, respectively). However, lower OR of all secondary outcomes were associated with concomitant GLP-1RA/SGLT-2i use when compared to SGLT-2i use alone. Conclusion Among adults who tested positive for SARS-CoV-2, premorbid use of either GLP-1RA or SGLT-2i is associated with lower odds of mortality compared to DPP-4i. Furthermore, concomitant use of GLP-1RA and SGLT-2i is linked to lower odds of other severe COVID-19 outcomes, including ER visits, hospitalizations, and mechanical ventilation, compared to SGLT-2i use alone. Graphical abstract available for this article. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s13300-024-01562-1.

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Section: Discussionmentioning

confidence: 99%

Association of Premorbid GLP-1RA and SGLT-2i Prescription Alone and in Combination with COVID-19 Severity

Klein,

Abrahamsen,

Kahkoska

et al. 2024

Diabetes Ther

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Potential use of sodium glucose co-transporter 2 inhibitors during acute illness: a systematic review based on COVID-19

Tisch,

Xourgia,

Exadaktylos

et al. 2024

Endocrine

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Objective SGLT-2i are increasingly recognized for their benefits in patients with cardiometabolic risk factors. Additionally, emerging evidence suggests potential applications in acute illnesses, including COVID-19. This systematic review aims to evaluate the effects of SGLT-2i in patients facing acute illness, particularly focusing on SARS-CoV-2 infection. Methods Following PRISMA guidelines, a systematic search of PubMed, Scopus, medRxiv, Research Square, and Google Scholar identified 22 studies meeting inclusion criteria, including randomized controlled trials and observational studies. Data extraction and quality assessment were conducted independently. Results Out of the 22 studies included in the review, six reported reduced mortality in DM-2 patients taking SGLT-2i, while two found a decreased risk of hospitalization. Moreover, one study demonstrated a lower in-hospital mortality rate in DM-2 patients under combined therapy of metformin plus SGLT-2i. However, three studies showed a neutral effect on the risk of hospitalization. No increased risk of developing COVID-19 was associated with SGLT-2i use in DM-2 patients. Prior use of SGLT-2i was not associated with ICU admission and need for MV. The risk of acute kidney injury showed variability, with inconsistent evidence regarding diabetic ketoacidosis. Conclusion Our systematic review reveals mixed findings on the efficacy of SGLT-2i use in COVID-19 patients with cardiometabolic risk factors. While some studies suggest potential benefits in reducing mortality and hospitalizations, others report inconclusive results. Further research is needed to clarify optimal usage and mitigate associated risks, emphasizing caution in clinical interpretation.

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Impact of blood glucose control on clinical outcomes in type 2 diabetes patients hospitalized with COVID-19 infection

Chertok Shacham,

Maman,

Ishay

2024

Diabetes and Vascular Disease Research

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Our study evaluates the interconnection between diabetes treatment in the community setting and diabetes treatment regimens in these patients during hospitalization. Methods The patients were divided into four groups according to blood glucose level during hospitalization. Group 1 included patients with an average blood glucose ≤140 mg/dl, Group 2 included patients with an average blood glucose level between 140 and 180 mg/dl, Group 3 included patients whose blood glucose level was between 180 and 250 mg/dl, and Group 4 included patients with average blood glucose >250 mg/dl. In all subjects, we assessed preadmission diabetes treatment and prior diagnoses of major comorbidities (atherosclerotic cardiovascular disease, congestive heart failure, chronic renal disease, chronic pulmonary diseases, and dementia. Results Significant predictors of mortality were the severity of COVID-19 (OR 62, CI 95%; 18–235, p < .000), acute renal failure (OR 3.2, CI 95% - 1.26–8.2; p = .015), and a diagnosis of congestive heart failure before hospitalization (OR 2.6; CI 95% 1.14–6.8; p = .024). Lower preadmission HbA1c levels, insulin treatment in the hospital, SGLT-2 treatment before, and absence of acute renal failure are significant predictors of good glycemic control during hospitalization. Conclusions In patients with type 2 diabetes hospitalized with COVID-19, poor long-term glycemic control is associated with the level of hyperglycemia during hospitalization.

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Effect of Antidiabetic Therapy on Clinical Outcomes of COVID-19 Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 119 publications

Association of Premorbid GLP-1RA and SGLT-2i Prescription Alone and in Combination with COVID-19 Severity

Association of Premorbid GLP-1RA and SGLT-2i Prescription Alone and in Combination with COVID-19 Severity

Potential use of sodium glucose co-transporter 2 inhibitors during acute illness: a systematic review based on COVID-19

Impact of blood glucose control on clinical outcomes in type 2 diabetes patients hospitalized with COVID-19 infection

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