COVID-19 and Diabetes Mellitus: Are there any Differences in Outcomes with Anti-Diabetic Drugs?

Öz

Aim: This study aims to analyze the effect of diabetes and diabetes drugs on the outcome of COVID-19 patients. Material and Methods: All the patients with diabetes hospitalized for COVID-19 between March 15, 2020 and June 15, 2020 at Istanbul University Faculty of Medicine were screened. Outcomes of the patients were compared with patients without diabetes. Results: Among six hundred fourteen patients (59.8% male, n=367) there were 151 patients with diabetes (24.5%). Patients with diabetes were hospitalized longer than patients without (12.1±10.3 vs. 10.2±7.3, p=0.037 in days), had higher intensive care unit (ICU) hospitalization rate (20.5% (n=31) vs. 12.0% (n=56), p=0.016, OR:1.8 (1.1-2.9)) and mortality rate (15.8% (n=24) vs. 7.7% (n=36, p=0.007), OR:2.1(1.2-3.8)). There was no difference in admission to ICU between patients who use metformin, basal insulin or bolus insulin regarding admission to ICU compared to patients who don’t (p= 0.32, p=0.22 and p=0.64, respectively). No patient on sodium-glucose co-transporter-2 treatment was treated in ICU. Death rate didn’t differ between patients regarding their treatment modalities. Conclusion: Patients with diabetes had worse outcomes than non-diabetic patients, and according to our findings and no anti-diabetic drug has a beneficial or harmful effect.

Anahtar Kelimeler

• COVID-19
• Diabetes medication
• Sodium-glucose co-transporter-2
• Metformin

Covid-19 ve Diyabet: Antidiyabetik İlaçlar ile Sonlanımlarda Fark Var mı?

Öz

Amaç: Bu çalışma, diyabet ve diyabet ilaçlarının COVID-19 hastalarının sonuçları üzerindeki etkisini analiz etmeyi amaçlamaktadır. Gereç ve Yöntemler: 15 Mart 2020-15 Haziran 2020 tarihleri arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi'nde COVID-19 nedeniyle hastaneye yatırılan tüm diyabet hastaları tarandı. Hastaların sonuçları diyabeti olmayan hastalarla karşılaştırıldı. Bulgular: Altı yüz ondört hastanın (%59,8 erkek, n=367) 151 tanesi diyabet hastası (%24,5) idi. Diyabetli hastalar diyabeti olmayan hastalardan daha uzun süre hastanede yattı (12,1±10,3'e karşı 10,2±7,3 /gün p=0,037), diyabetlilerin yoğun bakım ünitesinde (YBÜ) yatış oranı (20,5% (n=31) ve 12,0% (n) =56), p=0,016, OR:1,8 (1,1-2,9)) ve ölüm oranları (%15,8 (n=24) ve %7,7 (n=36, p=0,007), OR:2,1(1,2-3,8)) daha yüksekti. Metformin, bazal insülin veya bolus insülin kullanan hastaların YBÜ’e yatışı açısından kullanmayanlara göre fark yoktu (sırasıyla p=0,32, p=0,22 ve p=0,64). Sodyum-glukoz kotransporter-2 tedavisi alan hiçbir hasta YBÜ'de tedavi edilmedi. Diyabet hastalarının ölüm oranı, aldıkları tedavi yöntemlerine göre hastalar arasında farklılık göstermedi. Sonuç: Diyabetli hastalar diyabetik olmayan hastalara göre daha kötü sonuçlara sahipti ve bizim bulgularımıza göre hiçbir antidiyabetik ilacın yararlı veya zararlı etkisi yoktu.

Anahtar Kelimeler

• COVID-19
• Diyabet tedavisi
• Sodyum glukoz kotransporter-2
• Metformin

Kaynakça

1. Reference1 Ji Y, Ma Z, Peppelenbosch MP, Pan Q. Potential association between COVID-19 mortality and health-care resource availability. The Lancet Global Health 2020.8(4): e480, Doi: 10.1016/S2214-109X(20)30068-1.
2. Reference2 Imam Z, Odish F, Gill I, O’Connor D, Armstrong J, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. Journal of Internal Medicine, 2020 Oct;288(4):469-476. Doi: 10.1111/joim.13119.
3. Reference3 Poblador-Plou B, Carmona-Pírez J, Ioakeim-Skoufa I, Poncel-Falcó A, Bliek-Bueno K et al. Baseline chronic comorbidity and mortality in laboratory-confirmed COVID-19 cases: Results from the PRECOVID study in Spain. International Journal of Environmental Research and Public Health, 2020;17(14):5171. Doi: 10.3390/ijerph17145171.
4. Reference4 Zhou F, Yu T, Du R, Fan G, Liu Y. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020; 28;395(10229):1054-1062. Doi: 10.1016/S0140-6736(20)30566-3.
5. Reference5 Guo W, Li M, Dong Y, Zhou H, Zhang Z. et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes/Metabolism Research and Reviews 2020; e3319. Doi: 10.1002/dmrr.3319.
6. Reference6 Guo L, Shi Z, Zhang Y, Wang C, Do Vale Moreira NC, et al. Comorbid diabetes and the risk of disease severity or death among 8807 COVID-19 patients in China: A meta-analysis. Diabetes Research and Clinical Practice 2020; 166:108346. Doi: 10.1016/j.diabres.2020.108346.
7. Reference7 Cheng X, Liu YM, Li H, Zhang X, Lei, F et al. Metformin Is Associated with Higher Incidence of Acidosis, but Not Mortality, in Individuals with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabolism 2020; 32(4):537-547. Doi: 10.1016/j.cmet.2020.08.013.
8. Reference8 Sharma S, Ray A, Sadasivam B. Metformin in COVID-19: A possible role beyond diabetes. Diabetes Research and Clinical Practice 2020; 164:108183. Doi: 10.1016/j.diabres.2020.108183.

9. Reference9 Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R et al. Clinical Characteristics of Covid-19 in New York City. New England Journal of Medicine 2020; 382(24):2372-2374. Doi: 10.1056/nejmc2010419.
10. Reference10 Bode B, Garrett V, Messler J, McFarland R, Crowe J. et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. Journal of Diabetes Science and Technology 2020; 14(4):813-821. Doi: 10.1177/1932296820924469.
11. Reference11 Ciardullo S, Zerbini F, Perra S, Muraca E, Cannistraci R, et al. Impact of diabetes on COVID-19-related in-hospital mortality: a retrospective study from Northern Italy. Journal of Endocrinological Investigation 2020; 1-8. Doi: 10.1007/s40618-020-01382-7.
12. Reference12 Mantovani A, Byrne CD, Zheng MH, Targher G. Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: A meta-analysis of observational studies. Nutrition, Metabolism and Cardiovascular Diseases 2020; 30(8):1236-1248. Doi: 10.1016/j.numecd.2020.05.014.
13. Reference13 Holman N, Knighton P, Kar P, O’Keefe J, Curley M et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. The Lancet Diabetes and Endocrinology 2020; 8(10):823-833. Doi: 10.1016/S2213-8587(20)30271-0.
14. Reference14 Chen Y, Yang D, Cheng B, Chen J, Peng A et al. Clinical Characteristics and Outcomes of Patients with Diabetes and COVID-19 in Association with Glucose-Lowering Medication. Diabetes Care 2020; 43(7):1399-1407.Doi: 10.2337/dc20-0660.
15. Reference15 Dalan R, Ang LW, Tan WYT, Fong S-W, Tay WC et al. The association of hypertension and diabetes pharmacotherapy with COVID-19 severity and immune signatures: an observational study. European Heart Journal - Cardiovascular Pharmacotherapy 2020; Doi: 10.1093/ehjcvp/pvaa098.
16. Reference16 Yu B, Li C, Sun Y, Wang DW. Insulin Treatment Is Associated with Increased Mortality in Patients with COVID-19 and Type 2 Diabetes. Cell Metabolism 2021.33(1): 65-77.e2, Doi: 10.1016/j.cmet.2020.11.014.
17. Reference17 Riahi S, Sombra LRS, Lo KB, Chacko SR, Neto AGM et al. Insulin Use, Diabetes Control, and Outcomes in Patients with COVID-19. Endocrine Research 2020; 00(00): 1–6, Doi: 10.1080/07435800.2020.1856865.
18. Reference18 Solerte SB, Di Sabatino A, Galli M, Fiorina P. Dipeptidyl peptidase-4 (DPP4) inhibition in COVID-19. Acta Diabetologica 2020; 57(7): 779–783, Doi: 10.1007/s00592-020-01539-z.
19. Reference19 Strollo R, Maddaloni E, Dauriz M, Pedone C, Buzzetti R et al. Use of DPP4 inhibitors in Italy does not correlate with diabetes prevalence among COVID-19 deaths. Diabetes Research and Clinical Practice 2021; 171: 108444, Doi: 10.1016/j.diabres.2020.108444.