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

• Published in: Diabetes & metabolism Vol. 47; no. 5; p. 101216
• Main Authors: Lalau, Jean-Daniel, Al-Salameh, Abdallah, Hadjadj, Samy, Goronflot, Thomas, Wiernsperger, Nicolas, Pichelin, Matthieu, Allix, Ingrid, Amadou, Coralie, Bourron, Olivier, Duriez, Thierry, Gautier, Jean-François, Dutour, Anne, Gonfroy, Céline, Gouet, Didier, Joubert, Michael, Julier, Ingrid, Larger, Etienne, Marchand, Lucien, Marre, Michel, Meyer, Laurent, Olivier, Frédérique, Prevost, Gaëtan, Quiniou, Pascale, Raffaitin-Cardin, Christelle, Roussel, Ronan, Saulnier, Pierre-Jean, Seret-Begue, Dominique, Thivolet, Charles, Vatier, Camille, Desailloud, Rachel, Wargny, Matthieu, Gourdy, Pierre, Cariou, Bertrand
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.09.2021; Elsevier Masson
• Subjects: Aged; Aged, 80 and over; COVID-19; COVID-19 - complications; COVID-19 - mortality; COVID-19 - therapy; Death; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - mortality; Female; Hospitalization; Humans; Hypoglycemic Agents - therapeutic use; Life Sciences; Male; Mechanical ventilation; Metformin; Metformin - therapeutic use; Middle Aged; Original; Propensity Score; Respiration, Artificial - mortality; Type 2 diabetes; COVID-19; Type 2 diabetes; Death; Propensity score; Metformin; Mechanical ventilation; Covid-19
• ISSN: 1262-3636; 1878-1780; 1878-1780
• DOI: 10.1016/j.diabet.2020.101216

Metformin exerts anti-inflammatory and immunosuppressive effects. We addressed the impact of prior metformin use on prognosis in patients with type 2 diabetes hospitalised for COVID-19. CORONADO is a nationwide observational study that included patients with diabetes hospitalised for COVID-19 between March 10 and April 10, 2020 in 68 French centres. The primary outcome combined tracheal intubation and/or death within 7 days of admission. A Kaplan-Meier survival curve was reported for death up to day 28. The association between metformin use and outcomes was then estimated in a logistic regression analysis after applying a propensity score inverse probability of treatment weighting approach. Among the 2449 patients included, 1496 were metformin users and 953 were not. Compared with non-users, metformin users were younger with a lower prevalence of diabetic complications, but had more severe features of COVID-19 on admission. The primary endpoint occurred in 28.0% of metformin users (vs 29.0% in non-users, P =  0.6134) on day 7 and in 32.6% (vs 38.7%, P = 0.0023) on day 28. The mortality rate was lower in metformin users on day 7 (8.2 vs 16.1%, P <  0.0001) and on day 28 (16.0 vs 28.6%, P < 0.0001). After propensity score weighting was applied, the odds ratios for primary outcome and death (OR [95%CI], metformin users vs non-users) were 0.838 [0.649−1.082] and 0.688 [0.470−1.007] on day 7, then 0.783 [0.615−0.996] and 0.710 [0.537−0.938] on day 28, respectively. Metformin use appeared to be associated with a lower risk of death in patients with diabetes hospitalised for COVID-19.