Insulin Use and Poor COVID-19 Outcomes among Diabetes Patients: Association Not Necessarily Causation

Riahi, Shayan; Lo, Kevin Bryan; Anastasopoulou, Catherine; Rangaswami, Janani

doi:10.1080/07435800.2021.1894821

Cited by 2 publications

(1 citation statement)

References 3 publications

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“… 36 It is difficult to rule out the negative effect of the more advanced diabetes on poor outcomes, especially in severe cases. Riahi et al 37 indicated that the association between insulin use and poor outcomes did not necessarily mean causation, as the severity of diabetes might play a bigger role in determining clinical outcomes among patients with COVID-19. 16 , 38 At present, the basal-bolus insulin regimen is still encouraged to be adopted in COVID-19 patients with T2D, especially in patients with acute hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

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

Zhan

Weng

Li³

et al. 2022

Ann Pharmacother

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Background: No study has yet systematically evaluated the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with type 2 diabetes (T2D). Objective: We aimed to evaluate the effect of different antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D. Methods: We comprehensively retrieved the published research which examined the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D. The odds ratio (OR) and its 95% confidence interval (95% CI) for clinical outcomes were calculated using the random-effects model, and meta-regression was adopted to evaluate the potential sources of heterogeneity between studies. Results: A total of 54 studies were included in this study. We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75). No statistically significant associations were identified for DPP-4i, SUs, AGIs, and TZDs. Conclusion and Relevance: We demonstrated that the usage of metformin, SGLT-2i, and GLP-1ra could significantly decrease mortality in COVID-19 patients with T2D. The heterogeneity across the studies, baseline characteristics of the included patients, shortage of dosage and the duration of antidiabetic drugs and autonomy of drug selection might limit the objectivity and accuracy of results. Further adequately powered and high-quality randomized controlled trials are warranted for conclusive findings.

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Section: Discussionmentioning

confidence: 99%

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

Zhan

Weng

Li³

et al. 2022

Ann Pharmacother

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Short- and long-term prognosis of glycemic control in COVID-19 patients with type 2 diabetes

Zhan

Zhang

Wang

et al. 2022

QJM: An International Journal of Medicine

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Background and aim To systematically evaluate the associations between glycemic control and short- to long-term outcomes in coronavirus disease 2019 (COVID-19) patients with type 2 diabetes (T2D). Design and methods A multi-center prospective cohort study including 574 COVID-19 patients with T2D were conducted in Wuhan, China. All patients were followed-up 1 year after hospital discharge using a uniformed questionnaire including self-reported symptoms, and the chronic obstructive pulmonary disease (COPD) assessment test (CAT) items. Results Of the 574 patients, 443 (77.2%) had well-controlled blood glucose. Glycemic control was significantly associated with decreased risk of death (OR: 0.24, 95% CI: 0.10-0.57), ICU admission (OR: 0.22, 95% CI: 0.10-0.49), invasive mechanical ventilation (OR: 0.25, 95% CI: 0.08-0.72), disease progression (OR: 0.25, 95% CI: 0.11-0.55), and composite outcome (OR: 0.26, 95% CI: 0.14-0.49). The top five long-term sequelae include fatigue (31.5%), sweating (21.2%), chest tightness (15.1%), anxiety (12.2%), myalgia (10.6%), and short breath (6.4%). Glycemic control was associated with decreased risk of respiratory sequelae (OR: 0.42, 95% CI: 0.18-0.99, P = 0.048). Conclusions Glycemic control was significantly associated with short-term outcomes in COVID-19 patients with T2D, and showed a significant association with long-term respiratory sequelae. The management and control of blood glucose has a positive impact on prognosis of COVID-19.

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Insulin Use and Poor COVID-19 Outcomes among Diabetes Patients: Association Not Necessarily Causation

Cited by 2 publications

References 3 publications

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

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

Short- and long-term prognosis of glycemic control in COVID-19 patients with type 2 diabetes

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