Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Avenida de Carlos Haya, s/n, 29010, Málaga, Spain.
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain.
BMC Med. 2020 Nov 16;18(1):359. doi: 10.1186/s12916-020-01832-2.
Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay.
We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine's registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100.
A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays.
In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed.
关于降糖药物在 COVID-19 患者中的作用，现有证据有限。我们的主要目的是分别检查住院期间死亡与在家使用的每种常规降糖药物的关联，以及与二甲双胍联合使用的关联，这些药物用于因 COVID-19 住院的 2 型糖尿病患者。我们还评估了它们与 ICU 入院、有创和无创机械通气或住院期间死亡的复合结局的关联，以及与院内并发症和长时间住院的关联。
我们从西班牙内科医师学会的 COVID-19 患者登记处（SEMI-COVID-19 登记处）中选择了所有 2 型糖尿病患者。这是一项正在进行的、观察性的、多中心、全国性的西班牙 COVID-19 住院患者队列研究，从 2020 年 3 月 1 日开始。每位降糖药物使用者均通过倾向评分与其他降糖药物使用者进行 1:1 匹配。为了评估倾向评分匹配的充分性，我们使用匹配后患者特征中的标准化均差进行评估。如果发现标准化均差>10%，则认为组间存在显著不平衡。如果样本量≥100，则使用条件逻辑回归和混合效应逻辑回归来评估治疗与研究结局之间的关系。
SEMI-COVID-19 登记处共发现 2666 例患者，其中 1297 例接受单药降糖治疗，465 例接受二甲双胍联合治疗。经倾向评分匹配后，选择了 249 例使用二甲双胍、105 例使用二肽基肽酶-4 抑制剂、129 例使用胰岛素、127 例使用二甲双胍/二肽基肽酶-4 抑制剂、34 例使用二甲双胍/钠-葡萄糖共转运蛋白 2 抑制剂和 67 例使用二甲双胍/胰岛素。在家使用的降糖药物与住院期间死亡、需要入住 ICU、机械通气或住院期间死亡的复合结局、院内并发症或长时间住院均无显著关联。
在因 COVID-19 住院的 2 型糖尿病患者中，在家使用的降糖药物与死亡率和不良结局无显著关联。鉴于糖尿病与 COVID-19 之间的密切关系以及降糖药物作用的有限证据，需要开展前瞻性研究。
