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Klein KR, Abrahamsen TJ, Kahkoska AR, Alexander GC, Chute CG, Haendel M, Hong SS, Mehta H, Moffitt R, Stürmer T, Kvist K, Buse JB. Association of Premorbid GLP-1RA and SGLT-2i Prescription Alone and in Combination with COVID-19 Severity. Diabetes Ther 2024; 15:1169-1186. [PMID: 38536629 PMCID: PMC11043305 DOI: 10.1007/s13300-024-01562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
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.
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Affiliation(s)
- Klara R Klein
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Campus Box #7172, 8072 Burnett Womack, 160 Dental Circle, Chapel Hill, NC, 27599, USA.
| | | | - Anna R Kahkoska
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Campus Box #7172, 8072 Burnett Womack, 160 Dental Circle, Chapel Hill, NC, 27599, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Melissa Haendel
- Center for Health AI, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephanie S Hong
- Division of General Internal Medicine, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hemalkumar Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Richard Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - John B Buse
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Campus Box #7172, 8072 Burnett Womack, 160 Dental Circle, Chapel Hill, NC, 27599, USA
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Song ZH, Huang QM, Xu SS, Zhou JB, Zhang C. The Effect of Antihyperglycemic Medications on COVID-19: A Meta-analysis and Systematic Review from Observational Studies. Ther Innov Regul Sci 2024:10.1007/s43441-024-00633-6. [PMID: 38683419 DOI: 10.1007/s43441-024-00633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/09/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Diabetes, a chronic disease worldwide, may be associated with a poorer prognosis in patients with coronavirus disease 2019 (COVID-19). While some antihyperglycemic medications may be beneficial, others may increase the risk of adverse clinical outcomes of COVID-19. We aimed to analyze the effect of antihyperglycemic medications on COVID-19. METHODS We searched the Web of Science, Cochrane Library, EMBASE, PubMed, and Scopus databases from December 2019 to June 2022 to identify literature related to patients with COVID-19 and type 2 diabetes mellitus (T2DM) treated with antihyperglycemic medications. RESULTS 56 studies were included in the analysis. Metformin (OR 0.66; 95% CI 0.58-0.74; p < 0.05), Glucagon-like peptide-1 receptor agonist (GLP-1ra) (OR 0.73; 95% CI 0.59-0.91; p < 0.05), and sodium-dependent glucose transporters 2 inhibitor (SGLT 2i) (OR 0.77; 95% CI 0.69-0.87; p < 0.05) were associated with lower mortality risk, while insulin was associated with increased mortality risk (OR 1.40; 95% CI 1.26-1.55; p < 0.05). Meanwhile, metformin (OR 0.65; 95% CI 0.50-0.85; p < 0.05) and GLP-1ra (OR 0.84; 95% CI 0.76-0.94; p < 0.05) were significantly associated with decreased severe manifestation risk. What's more, metformin (OR 0.77; 95% CI 0.62-0.96; p < 0.05), GLP-1ra (OR 0.86; 95% CI 0.81-0.92; p < 0.05), and SGLT 2i (OR 0.87; 95% CI 0.79-0.97; p < 0.05) were also associated with a decreased risk of hospitalization, but insulin were associated with an increased risk of hospitalization (OR 1.31; 95% CI 1.12-1.52; p < 0.05). Nevertheless, the results of the subgroup analyses showed that the effects of different glucose-lowering agents on COVID-19 may be related to in-hospital use or out-hospital use, elderly or non-elderly patients use, and different geography. CONCLUSION Metformin, GLP-1ra, and SGLT 2i have shown a positive effect on clinical outcomes in COVID-19, particularly in non-elderly individuals. However, insulin use may pose a higher risk, especially in elderly patients, so need with caution. Meanwhile, DPP-4i, TZD, α-GLUi, and sulfonylureas appeared to have a neutral effect. These results need to be validated in future clinical studies.
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Affiliation(s)
- Zhi-Hui Song
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiao-Ming Huang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shan-Shan Xu
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian-Bo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Chao Zhang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Tisch C, Xourgia E, Exadaktylos A, Ziaka M. Potential use of sodium glucose co-transporter 2 inhibitors during acute illness: a systematic review based on COVID-19. Endocrine 2024:10.1007/s12020-024-03758-8. [PMID: 38448675 DOI: 10.1007/s12020-024-03758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
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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Affiliation(s)
- Carmen Tisch
- Department of Internal Medicine, Thun General Hospital, Thun, Switzerland
| | - Eleni Xourgia
- Department of Cardiology, Inselspital, University Hospital, University of Bern, 3008, Bern, Switzerland
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Mairi Ziaka
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
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Orioli L, Servais T, Crenier L, Oriot P, Yombi JC, Hermans MP. Authors' reply to correspondence to "Mortality-related risk factors of inpatients with diabetes and COVID-19: A multicenter retrospective study in Belgium. Ann Endocrinol (Paris). 2023 Aug 31:S0003-4266(23)00685-6. doi: 10.1016/j.ando.2023.08.002". Ann Endocrinol (Paris) 2023; 84:790-791. [PMID: 37951796 DOI: 10.1016/j.ando.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Laura Orioli
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - Thomas Servais
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Laurent Crenier
- Department of Endocrinology, Hôpital Erasme, Cliniques Universitaires de Bruxelles, route de Lennik 808, 1070 Brussels, Belgium
| | - Philippe Oriot
- Department of Diabetology, Centre Hospitalier de Mouscron, avenue de Fécamp 49, 7700 Mouscron, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Michel Paul Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
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Obiri-Yeboah D, Bena J, Alwakeel M, Buehler L, Makin V, Zhou K, Pantalone KM, Lansang MC. Association of Metformin, Dipeptidyl Dipeptidase-4 Inhibitors, and Insulin with Coronavirus Disease 2019-Related Hospital Outcomes in Patients with Type 2 Diabetes. Endocr Pract 2023; 29:681-685. [PMID: 37301375 PMCID: PMC10250053 DOI: 10.1016/j.eprac.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The effects of diabetes medications on COVID-19 hospitalization outcomes have not been consistent. We sought to determine the effect of metformin, dipeptidyl peptidase-4 inhibitors (DPP-4i), and insulin on admission to the intensive care unit (ICU), need for assisted ventilation, development of renal insufficiency, and mortality in patients admitted with COVID-19 infection after controlling for clinical variables and other relevant diabetes-related medications in patients with type 2 diabetes mellitus (DM). METHODS This was a retrospective study of patients hospitalized with COVID-19 from a single hospital system. Univariate and multivariate analyses were performed that included demographic data, glycated hemoglobin, kidney function, smoking status, insurance, Charlson comorbidity index, number of diabetes medications, and use of angiotensin-converting enzyme inhibitors and statin prior to admission and glucocorticoids during admission. RESULTS A total of 529 patients with type 2 DM were included in our final analysis. Neither metformin nor DPP4i prescription was associated with ICU admission, need for assisted ventilation, or mortality. Insulin prescription was associated with increased ICU admission but not with need for assisted ventilation or mortality. There was no association of any of these medications with development of renal insufficiency. CONCLUSIONS In this population, limited to type 2 DM and controlled for multiple variables that have not been consistently studied (such as a measure of general health, glycated hemoglobin, and insurance status), insulin prescription was associated with increased ICU admission. Metformin and DPP4i prescriptions did not have an association with the outcomes.
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Affiliation(s)
- Derrick Obiri-Yeboah
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Mahmoud Alwakeel
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lauren Buehler
- Department of Endocrinology, Conway Medical Center, Conway, South Carolina
| | - Vinni Makin
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Keren Zhou
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Kevin M Pantalone
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - M Cecilia Lansang
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio.
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Kow CS, Ramachandram DS, Hasan SS. The impact of preadmission/prediagnosis use of GLP-1 receptor agonists on COVID-19 mortality in patients with diabetes: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1549. [PMID: 37720167 PMCID: PMC10500111 DOI: 10.1002/hsr2.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Chia Siang Kow
- Department of Pharmacy PracticeSchool of Pharmacy, International Medical UniversityKuala LumpurMalaysia
| | | | - Syed Shahzad Hasan
- Department of PharmacySchool of Applied Sciences, University of HuddersfieldHuddersfieldUK
- School of Biomedical Sciences & PharmacyUniversity of NewcastleCallaghanAustralia
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Schlesinger S, Lang A, Christodoulou N, Linnerz P, Pafili K, Kuss O, Herder C, Neuenschwander M, Barbaresko J, Roden M. Risk phenotypes of diabetes and association with COVID-19 severity and death: an update of a living systematic review and meta-analysis. Diabetologia 2023; 66:1395-1412. [PMID: 37204441 PMCID: PMC10198038 DOI: 10.1007/s00125-023-05928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 03/16/2023] [Indexed: 05/20/2023]
Abstract
AIMS/HYPOTHESIS To provide a systematic overview of the current body of evidence on high-risk phenotypes of diabetes associated with COVID-19 severity and death. METHODS This is the first update of our recently published living systematic review and meta-analysis. Observational studies investigating phenotypes in individuals with diabetes and confirmed SARS-CoV-2 infection with regard to COVID-19-related death and severity were included. The literature search was conducted from inception up to 14 February 2022 in PubMed, Epistemonikos, Web of Science and the COVID-19 Research Database and updated using PubMed alert to 1 December 2022. A random-effects meta-analysis was used to calculate summary relative risks (SRRs) with 95% CIs. The risk of bias was evaluated using the Quality in Prognosis Studies (QUIPS) tool and the certainty of evidence using the GRADE approach. RESULTS A total of 169 articles (147 new studies) based on approximately 900,000 individuals were included. We conducted 177 meta-analyses (83 on COVID-19-related death and 94 on COVID-19 severity). Certainty of evidence was strengthened for associations between male sex, older age, blood glucose level at admission, chronic insulin use, chronic metformin use (inversely) and pre-existing comorbidities (CVD, chronic kidney disease, chronic obstructive pulmonary disease) and COVID-19-related death. New evidence with moderate to high certainty emerged for the association between obesity (SRR [95% CI] 1.18 [1.04, 1.34], n=21 studies), HbA1c (53-75 mmol/mol [7-9%]: 1.18 [1.06, 1.32], n=8), chronic glucagon-like peptide-1 receptor agonist use (0.83 [0.71, 0.97], n=9), pre-existing heart failure (1.33 [1.21, 1.47], n=14), pre-existing liver disease (1.40 [1.17, 1.67], n=6), the Charlson index (per 1 unit increase: 1.33 [1.13, 1.57], n=2), high levels of C-reactive protein (per 5 mg/l increase: 1.07 [1.02, 1.12], n=10), aspartate aminotransferase level (per 5 U/l increase: 1.28 [1.06, 1.54], n=5), eGFR (per 10 ml/min per 1.73 m2 increase: 0.80 [0.71, 0.90], n=6), lactate dehydrogenase level (per 10 U/l increase: 1.03 [1.01, 1.04], n=7) and lymphocyte count (per 1×109/l increase: 0.59 [0.40, 0.86], n=6) and COVID-19-related death. Similar associations were observed between risk phenotypes of diabetes and severity of COVID-19, with some new evidence on existing COVID-19 vaccination status (0.32 [0.26, 0.38], n=3), pre-existing hypertension (1.23 [1.14, 1.33], n=49), neuropathy and cancer, and high IL-6 levels. A limitation of this study is that the included studies are observational in nature and residual or unmeasured confounding cannot be ruled out. CONCLUSIONS/INTERPRETATION Individuals with a more severe course of diabetes and pre-existing comorbidities had a poorer prognosis of COVID-19 than individuals with a milder course of the disease. REGISTRATION PROSPERO registration no. CRD42020193692. PREVIOUS VERSION This is a living systematic review and meta-analysis. The previous version can be found at https://link.springer.com/article/10.1007/s00125-021-05458-8 FUNDING: The German Diabetes Center (DDZ) is funded by the German Federal Ministry of Health and the Ministry of Culture and Science of the State North Rhine-Westphalia. This study was supported in part by a grant from the German Federal Ministry of Education and Research to the German Center for Diabetes Research (DZD).
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Affiliation(s)
- Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany.
| | - Alexander Lang
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikoletta Christodoulou
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Linnerz
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kalliopi Pafili
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Manuela Neuenschwander
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
| | - Janett Barbaresko
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Mehdi SF, Pusapati S, Anwar MS, Lohana D, Kumar P, Nandula SA, Nawaz FK, Tracey K, Yang H, LeRoith D, Brownstein MJ, Roth J. Glucagon-like peptide-1: a multi-faceted anti-inflammatory agent. Front Immunol 2023; 14:1148209. [PMID: 37266425 PMCID: PMC10230051 DOI: 10.3389/fimmu.2023.1148209] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/26/2023] [Indexed: 06/03/2023] Open
Abstract
Inflammation contributes to many chronic conditions. It is often associated with circulating pro-inflammatory cytokines and immune cells. GLP-1 levels correlate with disease severity. They are often elevated and can serve as markers of inflammation. Previous studies have shown that oxytocin, hCG, ghrelin, alpha-MSH and ACTH have receptor-mediated anti-inflammatory properties that can rescue cells from damage and death. These peptides have been studied well in the past century. In contrast, GLP-1 and its anti-inflammatory properties have been recognized only recently. GLP-1 has been proven to be a useful adjuvant therapy in type-2 diabetes mellitus, metabolic syndrome, and hyperglycemia. It also lowers HbA1C and protects cells of the cardiovascular and nervous systems by reducing inflammation and apoptosis. In this review we have explored the link between GLP-1, inflammation, and sepsis.
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Affiliation(s)
- Syed Faizan Mehdi
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Suma Pusapati
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Muhammad Saad Anwar
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Durga Lohana
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Parkash Kumar
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | | | - Fatima Kausar Nawaz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Kevin Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Huan Yang
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Derek LeRoith
- Division of Endocrinology, Diabetes & Bone Disease, Icahn School of Medicine at Mt. Sinai, New York, NY, United States
| | | | - Jesse Roth
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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Nagendra L, Bhattacharya S, Kalra S, Kapoor N. Metformin in COVID-19: Is There a Role Beyond Glycemic Control? Int J Endocrinol Metab 2023; 21:e132965. [PMID: 37654526 PMCID: PMC10467582 DOI: 10.5812/ijem-132965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/26/2023] [Accepted: 04/15/2023] [Indexed: 09/02/2023] Open
Abstract
Context The coronavirus disease 2019 (COVID-19) pandemic is still a cause of worldwide health concern. Diabetes and its associated comorbidities are risk factors for mortality and morbidity in COVID-19. Selecting the right antidiabetic drug to achieve optimal glycemic control might mitigate some of the negative impacts of diabetes. Metformin continues to be the most widely administered antidiabetic agent. There is evidence of its beneficial outcome in COVID-19 independent of its glucose-lowering effect. Evidence Acquisition A thorough literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science to identify studies investigating metformin in COVID-19. Results Several overlapping mechanisms have been proposed to explain its antiviral properties. It could bring about conformational changes in the angiotensin-converting enzyme-2 receptor and decrease viral entry. The effects on the mammalian target of the rapamycin pathway and cellular pH have been proposed to reduce viral protein synthesis and replication. The immunomodulatory effects of metformin might counter the detrimental effects of hyperinflammation associated with COVID-19. Conclusions These findings call for broader metformin usage to manage hyperglycemia in COVID-19.
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Affiliation(s)
- Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research (JSS AHER), Mysore, Karnataka, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
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Foresta A, Ojeda-Fernandez L, Macaluso G, Roncaglioni MC, Tettamanti M, Fortino I, Leoni O, Genovese S, Baviera M. Dipeptidyl Peptidase-4 Inhibitors, Glucagon-like Peptide-1 Receptor Agonists, and Sodium-Glucose Cotransporter-2 Inhibitors and COVID-19 Outcomes. Clin Ther 2023; 45:e115-e126. [PMID: 36933975 PMCID: PMC9974363 DOI: 10.1016/j.clinthera.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE It has been reported that dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have a role in modulation of inflammation associated with coronavirus disease 2019 (COVID-19). This study assessed the effect of these drug classes on COVID-19-related outcomes. METHODS Using a COVID-19 linkable administrative database, we selected patients aged ≥40 years with at least 2 prescriptions of DPP-4i, GLP-1 RA, or SGLT-2i or any other antihyperglycemic drug and a diagnosis of COVID-19 from February 15, 2020, to March 15, 2021. Adjusted odds ratios (ORs) with 95% CIs were used to calculate the association between treatments and all-cause and in-hospital mortality and COVID-19-related hospitalization. A sensitivity analysis was performed by using inverse probability treatment weighting. FINDINGS Overall, 32,853 subjects were included in the analysis. Multivariable models showed a reduction of the risk for COVID-19 outcomes for users of DPP-4i, GLP-1 RA, and SGLT-2i compared with nonusers, although statistical significance was reached only in DPP-4i users for total mortality (OR, 0.89; 95% CI, 0.82-0.97). The sensitivity analysis confirmed the main results reaching a significant reduction for hospital admission in GLP-1 RA users and in-hospital mortality in SGLT-2i users compared with nonusers. IMPLICATIONS This study found a beneficial effect in the risk reduction of COVID-19 total mortality in DPP-4i users compared with nonusers. A positive trend was also observed in users of GLP-1 RA and SGLT-2i compared with nonusers. Randomized clinical trials are needed to confirm the effect of these drug classes as potential therapy for the treatment of COVID-19.
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Affiliation(s)
- Andreana Foresta
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Luisa Ojeda-Fernandez
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giulia Macaluso
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ida Fortino
- Unità Organizzativa Osservatorio Epidemiologico Regionale, Lombardy Region, Milan, Italy
| | - Olivia Leoni
- Unità Organizzativa Osservatorio Epidemiologico Regionale, Lombardy Region, Milan, Italy
| | | | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Pedrosa AR, Martins DC, Rizzo M, Silva-Nunes J. Metformin in SARS-CoV-2 infection: A hidden path - from altered inflammation to reduced mortality. A review from the literature. J Diabetes Complications 2023; 37:108391. [PMID: 36621213 PMCID: PMC9807268 DOI: 10.1016/j.jdiacomp.2022.108391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
SARS-CoV-2 infection has been a major threat to human health and a huge challenge to Medicine. In only two years, COVID-19 affected >350 million people, causing >5.6 million deaths. Chronic inflammatory states, such as diabetes or obesity, are known risk factors for COVID-19 poorest outcomes, with higher risk for disease severity and greater mortality. Metformin remains on the first line of the management of hyperglycemia in type 2 diabetes. Through its anti-inflammatory and immunomodulatory mechanisms, metformin appears as an opportunity to control the dysregulated cytokine storm secondary to SARS-CoV-2 infection. Recent studies point towards a potential protective role of metformin in the course of COVID-19, showing that current or previous treatment with metformin associates with better outcomes.
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Affiliation(s)
- Ana Realista Pedrosa
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Department of Internal Medicine, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Diana Cruz Martins
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - José Silva-Nunes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; NOVA Medical School/Faculdade de Ciências Medicas, New University of Lisbon, Lisbon, Portugal; Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal.
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12
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Permana H, Audi Yanto T, Ivan Hariyanto T. Pre-admission use of sodium glucose transporter-2 inhibitor (SGLT-2i) may significantly improves Covid-19 outcomes in patients with diabetes: A systematic review, meta-analysis, and meta-regression. Diabetes Res Clin Pract 2023; 195:110205. [PMID: 36502891 PMCID: PMC9731816 DOI: 10.1016/j.diabres.2022.110205] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
AIMS This study aims to examine the effectiveness of using sodium glucose transporter-2 inhibitor (SGLT-2i) before hospital admission on Covid-19 outcomes in diabetic patients. METHODS A literature search was conducted using specific keywords until October 24th, 2022 on 4 databases: Medline, Scopus, Cochrane Library, and ClinicalTrials.gov. All articles regarding SGLT-2i in diabetic patients with Covid-19 were included in the study. Outcomes in this study were calculated using random-effect models to generate pooled odds ratio (OR) with 95% confidence intervals (CI). RESULTS A total of 17 studies were included in the analysis. Our meta-analysis showed that pre-admission use of SGLT-2i was associated with reduced mortality (OR 0.69; 95 %CI: 0.56 - 0.87, p = 0.001, I2 = 91 %) and severity of Covid-19 (OR 0.88; 95 %CI: 0.80 - 0.97, p = 0.008, I2 = 13 %). This benefit of SGLT-2i on Covid-19 mortality was not significantly affected by patient's factors such as age (p = 0.2335), sex (p = 0.2742), hypertension (p = 0.2165), heart failure (p = 0.1616), HbA1c levels (p = 0.4924), metformin use (p = 0.6617), duration of diabetes (p = 0.7233), and BMI (p = 0.1797). CONCLUSIONS This study suggests that SGLT-2i as glucose lowering treatment in patients with diabetes has a positive effect on Covid-19 outcomes, therefore can be considered as an antidiabetic drug of choice, especially during the Covid-19 pandemic. Short Title: SGLT-2i in diabetes and Covid-19. REGISTRATION DETAILS CRD42022369784.
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Affiliation(s)
- Hikmat Permana
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Padjadjaran University, Bandung, West Java 45363, Indonesia
| | - Theo Audi Yanto
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang 15811, Indonesia
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13
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Madaschi S, Resmini E, Bonfadini S, Massari G, Gamba P, Sandri M, Calza S, Cimino E, Zarra E, Dotti S, Mascadri C, Agosti B, Garrafa E, Girelli A. Predictive markers for clinical outcomes in a cohort of diabetic patients hospitalized for COVID-19. Diabetol Metab Syndr 2022; 14:168. [PMID: 36371199 PMCID: PMC9652602 DOI: 10.1186/s13098-022-00941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The role of glycemic control, both prior and during hospitalization, on mortality from COVID-19 in diabetic patients is debated. Furthermore, it is not clear whether hyperglycemia has a direct effect or requires inflammatory mechanisms. OBJECTIVE To identify predictors of clinical outcomes (in-hospital mortality, length of hospitalization, respiratory failure, need for intensive care), considering hyperglycemia, inflammation markers and clinical history. METHODS Retrospective observational study of 291 diabetic patients hospitalized with COVID-19 in the Spedali Civili di Brescia from February 1th 2020 to March 31th 2021, with also outpatient electronic records. Glucose, inflammatory parameters, creatinine were collected within 24 h after admission to the hospital. A causal mediation analysis allowed the estimation of the direct and indirect effects of hyperglycemia on mortality. RESULTS Glucose at admission ≥ 165 mg/dL and reduced renal function were associated with an increased risk of in-hospital mortality and length of hospitalization (all p < 0.001), while an increase in inflammatory parameters was significantly associated with an increased risk of all outcomes. High basophil count was associated with reduced mortality (p < 0.001). Hyperglycemia had a direct effect on mortality (p < 0.001); the indirect, through inflammatory markers, was significant only for absolute neutrophil count, C-Reactive protein and procalcitonin (p = 0.007, p = 0.029, p = 0.042). Patients with microvascular complications and with chronic kidney disease showed higher mortality (p = 0.03, p = 0.01). CONCLUSIONS Hyperglycemia at admission, renal function and inflammatory parameters were found to be predictors of in-hospital mortality, while an increased basophil count was protective. Hyperglycemia had a direct effect on mortality, the indirect effect was only through few markers and markedly lower than the direct one.
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Affiliation(s)
- Sara Madaschi
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Eugenia Resmini
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy.
| | - Silvia Bonfadini
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Giulia Massari
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Paola Gamba
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marco Sandri
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Elena Cimino
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Emanuela Zarra
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Silvia Dotti
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Mascadri
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Barbara Agosti
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Emirena Garrafa
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
- ASST Spedali Civili di Brescia, Department of Laboratory,, Brescia, Italy.
| | - Angela Girelli
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST degli Spedali Civili di Brescia, Brescia, Italy
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14
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Yeh HC, Kraschnewski JL, Kong L, Lehman EB, Heilbrunn ES, Williams P, Poger JM, Francis E, Bryce CL. Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland. BMJ Open Diabetes Res Care 2022; 10:10/3/e002774. [PMID: 35680172 PMCID: PMC9184995 DOI: 10.1136/bmjdrc-2022-002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify the demographic and clinical characteristics associated with adverse COVID-19 outcomes across a 12-month period in 2020 and 2021. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using electronic health records from five academic health systems in Pennsylvania and Maryland, including patients with COVID-19 with type 2 diabetes or at risk of type 2 diabetes. Patients were classified based on 30-day outcomes: (1) no hospitalization; (2) hospitalization only; or (3) a composite measure including admission to the intensive care unit (ICU), intubation, or death. Analyses were conducted in patients with type 2 diabetes and patients at risk of type 2 diabetes separately. RESULTS We included 15 725 patients with COVID-19 diagnoses between March 2020 and February 2021. Older age and higher Charlson Comorbidity Index scores were associated with higher odds of adverse outcomes, while COVID-19 diagnoses later in the study period were associated with lower odds of severe outcomes. In patients with type 2 diabetes, individuals on insulin treatment had higher odds for ICU/intubation/death (OR=1.59, 95% CI 1.27 to 1.99), whereas those on metformin had lower odds (OR=0.56, 95% CI 0.45 to 0.71). Compared with non-Hispanic White patients, Hispanic patients had higher odds of hospitalization in patients with type 2 diabetes (OR=1.73, 95% CI 1.36 to 2.19) or at risk of type 2 diabetes (OR=1.77, 95% CI 1.43 to 2.18.) CONCLUSIONS: Adults who were older, in racial minority groups, had multiple chronic conditions or were on insulin treatment had higher risks for severe COVID-19 outcomes. This study reinforced the urgency of preventing COVID-19 and its complications in vulnerable populations. TRIAL REGISTRATION NUMBER NCT02788903.
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Affiliation(s)
- Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Kraschnewski
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Emily S Heilbrunn
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Pamela Williams
- Cancer and Chronic Disease Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Jennifer M Poger
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cindy L Bryce
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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15
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Nguyen NN, Ho DS, Nguyen HS, Ho DKN, Li HY, Lin CY, Chiu HY, Chen YC. Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis. Metabolism 2022; 131:155196. [PMID: 35367460 PMCID: PMC8970613 DOI: 10.1016/j.metabol.2022.155196] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diabetes is an independent predictor of poor outcomes in patients with COVID-19. We compared the effects of the preadmission use of antidiabetic medications on the in-hospital mortality of patients with COVID-19 having type 2 diabetes. METHODS A systematic search of PubMed, EMBASE, Scopus and Web of Science databases was performed to include studies (except case reports and review articles) published until November 30, 2021. We excluded papers regarding in-hospital use of antidiabetic medications. We used a random-effects meta-analysis to calculate the pooled OR (95% CI) and performed a sensitivity analysis to confirm the robustness of the meta-analyses. MAIN FINDINGS We included 61 studies (3,061,584 individuals), which were rated as having low risk of bias. The OR (95% CI) indicated some medications protective against COVID-related death, including metformin [0.54 (0.47-0.62), I2 86%], glucagon-like peptide-1 receptor agonist (GLP-1RA) [0.51 (0.37-0.69), I2 85%], and sodium-glucose transporter-2 inhibitor (SGLT-2i) [0.60 (0.40-0.88), I2 91%]. Dipeptidyl peptidase-4 inhibitor (DPP-4i) [1.23 (1.07-1.42), I2 82%] and insulin [1.70 (1.33-2.19), I2 97%] users were more likely to die during hospitalization. Sulfonylurea, thiazolidinedione, and alpha-glucosidase inhibitor were mortality neutral [0.92 (95% CI 0.83-1.01, I2 44%), 0.90 (95% CI 0.71-1.14, I2 46%), and 0.61 (95% CI 0.26-1.45, I2 77%), respectively]. The sensitivity analysis indicated that our findings were robust. CONCLUSIONS Metformin, GLP-1RA, and SGLT-2i were associated with lower mortality rate in patients with COVID-19 having type 2 diabetes. DPP-4i and insulin were linked to increased mortality. Sulfonylurea, thiazolidinedione, and alpha-glucosidase inhibitors were mortality neutral. These findings can have a large impact on the clinicians' decisions amid the COVID-19 pandemic.
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Affiliation(s)
- Nam Nhat Nguyen
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Dung Si Ho
- Department of Geriatric Medicine, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam; Department of Pulmonology, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Hung Song Nguyen
- College of Medicine, Taipei Medical University, Taipei, Taiwan; Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Dang Khanh Ngan Ho
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yuan Lin
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Harindhanavudhi T, Areevut C, Sahakitrungruang T, Tharavanij T, Kietdumrongwong P, Ngimruksa O, Songsiri P, Pitukweerakul S, Tanathornkirati N, Kaewprasert N, Thamcharoen R, Karndumri K, Saetung S, Anthanont P, Kiattisakthavee P, Putkong S, Chotwanvirat P, Nartsupha Phattanasri C, Jinadit S, Korpaisarn S, Chusane M, Samittarucksa R, Lertrit A, Siangruangsang S, Sanpawithayakul K, Sathiravikarn W, Soisuwan S, Chevaisrakul P, Imsakul K, Thuptimtong P, Sakmanarit J, Somwang S, Prasartkaew H, Jerawatana R, Butadej S, Tachanivate P, Jongjaroenprasert W, Sripatong J, Chobtangsilp S, Kamnirdsittiseree P, Savetkairop B, Manosittisak W, Tantivatanasatien J, Hathaidechadusadee A, Reutrakul S. Implementation of Diabetes Care and Educational Program via Telemedicine in Patients with COVID-19 in Home Isolation in Thailand: A Real-World Experience. J Diabetes Investig 2022; 13:1448-1457. [PMID: 35394118 PMCID: PMC9114836 DOI: 10.1111/jdi.13804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 04/05/2022] [Indexed: 01/08/2023] Open
Abstract
Background The coronavirus disease (COVID‐19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self‐management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home‐isolated patients with COVID‐19 infection. Methods A retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed. Results A volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high‐risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same‐day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE® platform) to assess the patient's clinical status and need. Real‐time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin‐naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home. Conclusion Diabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID‐19 pandemic was safe and effective.
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Affiliation(s)
- Tasma Harindhanavudhi
- University of Minnesota, 420 Delaware St S.E., MMC 101, Minneapolis, Minnesota, 55455-2020, USA
| | - Chatvara Areevut
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | - Thipaporn Tharavanij
- Thammasat University hospital, 99/209 Moo 18, Paholyothin Rd, Pathum Thani, Thailand
| | - Pongtorn Kietdumrongwong
- BDMS Health Research Center, Bangkok, Dusit Medical Services, Plc., Huai Khwang, Bangkok, Thailand
| | | | - Patitta Songsiri
- Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Siwadon Pitukweerakul
- Endocrinology Department, Marshfield Medical Center, Marshfield, Wisconsin, 54449-5703, USA
| | | | | | | | | | - Sunee Saetung
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | - Pimjai Anthanont
- Thammasat University Hospital, 99/209 Moo 18, Paholyothin Rd, Pathum Thani, Thailand
| | | | - Sarapee Putkong
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | | | - Srikorn Jinadit
- Ramkhamhaeng Hospital, 436 Ramkhamhaeng Road, Hua Mak, Bangkok, Thailand
| | - Sira Korpaisarn
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | | | - Amornpan Lertrit
- Bhumirajanagarindra Kidney Institute Hospital, 8/99 Phayathai Rd, Ratchathewi, Bangkok, Thailand
| | | | | | - Waraporn Sathiravikarn
- Royal Medical Division, Bureau of the Royal Household, Chitralada Villa Royal Residence, Dusit Palace., Bangkok, Thailand
| | | | | | - Kanokporn Imsakul
- Faculty of Medicine Vajira Hospital., 681 Samsen Road, Bangkok, Thailand
| | | | | | - Supaporn Somwang
- Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok, Thailand
| | | | | | - Siriwan Butadej
- Research Center, Theptarin Hospital, 3850 Rama IV road, Bangkok, Thailand
| | | | | | | | | | | | | | - Warot Manosittisak
- Warot Clinic, 1383/5 Phaholyothin R. Samsennet Phayathai, Bangkok, Thailand
| | | | | | - Sirimon Reutrakul
- University of Illinois at Chicago, 835 S. Wolcott, suite E625, Chicago, Illinois, 60612, USA
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Affiliation(s)
- Despina Sanoudou
- 4th Department of Internal Medicine, Clinical Genomics and Pharmacogenomics Unit, 'Attikon' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Center for New Biotechnologies and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Molecular Biology Division, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Michael A Hill
- Dalton Cardiovascular Research Center and Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, 65211, MO, USA.
| | | | - Kevin Arao
- Department of Medicine, Boston VA Healthcare System and Boston University School of Medicine, Boston, MA 02115, USA
| | - Christos S Mantzoros
- Department of Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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18
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Chen Y, Lv X, Lin S, Arshad M, Dai M. The Association Between Antidiabetic Agents and Clinical Outcomes of COVID-19 Patients With Diabetes: A Bayesian Network Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:895458. [PMID: 35692410 PMCID: PMC9186017 DOI: 10.3389/fendo.2022.895458] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS This study aimed to assess the impact of different antidiabetic agents on individuals with diabetes and COVID-19. METHODS We searched PubMed, Web of Science, Embase, and Cochrane Library databases from inception to October 31, 2021 and included seven antidiabetic agents. The data were pooled via traditional pairwise meta-analysis and Bayesian network meta-analysis. RESULTS The pairwise meta-analysis included 35 studies. Metformin (odds ratio (OR), 0.74; P=0.001), dipeptidyl peptidase-4 inhibitors (DPP4i) (OR, 0.88; P=0.04), sodium-glucose cotransporter-2 inhibitors (SGLT2i) (OR, 0.82; P=0.001), and glucagon-like peptide-1 receptor agonists (GLP1RA) (OR, 0.91; P=0.02) treatment were associated with lower COVID-19 mortality in individuals with diabetes compared to respective non-users. However, insulin treatment resulted in higher mortality (OR, 1.8; P=0.001). Mortality did not significantly differ in sulfonylurea (OR, 0.97; P=0.56) and thiazolidinediones (TZDs) (OR, 1.00; P=0.96) users. Furthermore, due to limited data, we analyzed five antidiabetic agents (metformin, DPP4i, sulfonylurea, insulin, and SGLT2i) and found no association between them and severe disease risk (all P>0.05). The Bayesian network meta-analysis included 18 studies. GLP1RA and SGLT2i had the highest first and second rank probability (67.3% and 62.5%, respectively). Insulin showed the maximum probability of ranking seventh (97.0%). Metformin had the third and fourth highest rank probability of 44.8% and 38.9%, respectively. Meanwhile, DPP4i had the fifth-highest rank probability of 42.4%, followed by sulfonylurea at 45.1%. CONCLUSION Metformin, DPP4i, SGLT2i, and GLP1RA treatments were highly possible to reduced COVID-19 mortality risk in individuals with diabetes, while insulin might be related to increased mortality risk. Sulfonylurea and TZDs treatments were not associated with mortality. None of the antidiabetic agents studied were associated with the risk of severe disease. Additionally, GLP1RA probably had the most significant protective effect against death, followed by SGLT2i and metformin. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42021288200).
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Affiliation(s)
- Yidan Chen
- Department of Rheumatology & Immunology, West China Hospital of Sichuan University, Chengdu, China
| | - Xingfei Lv
- Department of Orthopedics, People’s Hospital of Zhongjiang County, Deyang, China
| | - Sang Lin
- Department of Rheumatology& Immunology, China-Japan Friendship Hospital, Beijing, China
| | - Mohammad Arshad
- Department of Pediatrics Surgery, Lok Nayak Hospital, New Delhi, India
| | - Mengjun Dai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Mengjun Dai,
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Fu Y, Hu L, Ren HW, Zuo Y, Chen S, Zhang QS, Shao C, Ma Y, Wu L, Hao JJ, Wang CZ, Wang Z, Yanagihara R, Deng Y. Prognostic Factors for COVID-19 Hospitalized Patients with Preexisting Type 2 Diabetes. Int J Endocrinol 2022; 2022:9322332. [PMID: 35047039 PMCID: PMC8763039 DOI: 10.1155/2022/9322332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) as a worldwide chronic disease combined with the COVID-19 pandemic prompts the need for improving the management of hospitalized COVID-19 patients with preexisting T2D to reduce complications and the risk of death. This study aimed to identify clinical factors associated with COVID-19 outcomes specifically targeted at T2D patients and build an individualized risk prediction nomogram for risk stratification and early clinical intervention to reduce mortality. METHODS In this retrospective study, the clinical characteristics of 382 confirmed COVID-19 patients, consisting of 108 with and 274 without preexisting T2D, from January 8 to March 7, 2020, in Tianyou Hospital in Wuhan, China, were collected and analyzed. Univariate and multivariate Cox regression models were performed to identify specific clinical factors associated with mortality of COVID-19 patients with T2D. An individualized risk prediction nomogram was developed and evaluated by discrimination and calibration. RESULTS Nearly 15% (16/108) of hospitalized COVID-19 patients with T2D died. Twelve risk factors predictive of mortality were identified. Older age (HR = 1.076, 95% CI = 1.014-1.143, p=0.016), elevated glucose level (HR = 1.153, 95% CI = 1.038-1.28, p=0.0079), increased serum amyloid A (SAA) (HR = 1.007, 95% CI = 1.001-1.014, p=0.022), diabetes treatment with only oral diabetes medication (HR = 0.152, 95%CI = 0.032-0.73, p=0.0036), and oral medication plus insulin (HR = 0.095, 95%CI = 0.019-0.462, p=0.019) were independent prognostic factors. A nomogram based on these prognostic factors was built for early prediction of 7-day, 14-day, and 21-day survival of diabetes patients. High concordance index (C-index) was achieved, and the calibration curves showed the model had good prediction ability within three weeks of COVID-19 onset. CONCLUSIONS By incorporating specific prognostic factors, this study provided a user-friendly graphical risk prediction tool for clinicians to quickly identify high-risk T2D patients hospitalized for COVID-19.
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Affiliation(s)
- Yuanyuan Fu
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Ling Hu
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Hong-Wei Ren
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Yi Zuo
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Shaoqiu Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Qiu-Shi Zhang
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Chen Shao
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Yao Ma
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Lin Wu
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Jun-Jie Hao
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Chuan-Zhen Wang
- Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Zhanwei Wang
- Cancer Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Richard Yanagihara
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Youping Deng
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
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