Metformin Use Is Associated With Reduced Mortality in a Diverse Population With Covid-19 and Diabetes

Abstract

BACKGROUND: Coronavirus disease-2019 (COVID-19) is a growing pandemic with an increasing death toll that has been linked to various comorbidities as well as racial disparity. However, the specific characteristics of these at-risk populations are still not known and approaches to lower mortality are lacking. METHODS: We conducted a retrospective electronic health record data analysis of 25,326 subjects tested for COVID-19 between 2/25/20 and 6/22/20 at the University of Alabama at Birmingham Hospital, a tertiary health care center in the racially diverse Southern U.S. The primary outcome was mortality in COVID-19-positive subjects and the association with subject characteristics and comorbidities was analyzed using simple and multiple linear logistic regression. RESULTS: The odds ratio of contracting COVID-19 was disproportionately high in Blacks/African-Americans (OR 2.6; 95%CI 2.19-3.10; p<0.0001) and in subjects with obesity (OR 1.93; 95%CI 1.64-2.28; p<0.0001), hypertension (OR 2.46; 95%CI 2.07-2.93; p<0.0001), and diabetes (OR 2.11; 95%CI 1.78-2.48; p<0.0001). Diabetes was also associated with a dramatic increase in mortality (OR 3.62; 95%CI 2.11-6.2; p<0.0001) and emerged as an independent risk factor in this diverse population even after correcting for age, race, sex, obesity and hypertension. Interestingly, we found that metformin treatment was independently associated with a significant reduction in mortality in subjects with diabetes and COVID-19 (OR 0.33; 95%CI 0.13-0.84; p=0.0210). CONCLUSION: Thus, these results suggest that while diabetes is an independent risk factor for COVID-19-related mortality, this risk is dramatically reduced in subjects taking metformin, raising the possibility that metformin may provide a protective approach in this high risk population.

Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19

“…Importantly, data on BMI were missing in more than 90% of the patients [30] . A large retrospective electronic health record data analysis in > 25,000 subjects tested for COVID-19 (n = 604 positive cases) found that metformin use was associated with reduced mortality in 239 subjects with diabetes and COVID-19 (OR: 0.38 [0.17−0.87]) [31] . Indeed, a large body of evidence suggests that obesity is associated with more severe clinical course of COVID-19 including higher mortality rate.…”

Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq

“…The available data from observational and retrospective studies showed controversial results regarding the association between metformin use and clinical adverse outcomes in patients with DM and COVID-19. Some studies showed no definite association between metformin use and clinical outcomes, including survival, and raised concerns about the possible risk of lactic acidosis in cases of multiple organ failure [ [13] , [14] , [15] ], while others reported that metformin use was associated with a higher risk of disease progression in patients with COVID-19 with DM during hospitalization [ 16 ]. However, five studies with a total of 6937 patients showed that metformin use was associated with reduction in mortality rate from COVID-19 infection [ 17 ].…”

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…Crouse and colleagues retrospectively analyzed outcomes using electronic health records at the University of Alabama from February 25 to June 22, 2020, identifying 604 individuals with COVID-19 (40% with T2D). While prior use of insulin did not impact clinical outcomes, antecedent metformin use (n = 76) prior to the diagnosis of COVID-19 was associated with a 50% reduction in mortality, relative to non-metformin-treated subjects, findings not explained by between-group differences in %HbA1c or BMI ( Crouse et al., 2020 ). A putative benefit of antecedent metformin use in the US was also inferred from a retrospective analysis of health care claims data from January 1 to June 7, 2020, identifying 6,256 individuals hospitalized with COVID-19 (40.7% with T2D or obesity) in the United Health Group Clinical Discovery database ( Bramante et al., 2021 ).…”