二甲双胍的使用与因 COVID-19 住院的糖尿病患者的死亡率降低相关。
Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19.
机构信息
Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, 80054 Amiens, France; PériTox = UMR_I 01, University of Picardie Jules Verne, Amiens, France.
Département d'Endocrinologie, Diabétologie et Nutrition, l'institut du Thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093 Nantes Cedex 01, France.
出版信息
Diabetes Metab. 2021 Sep;47(5):101216. doi: 10.1016/j.diabet.2020.101216. Epub 2020 Dec 10.
AIMS
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.
METHODS
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.
RESULTS
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.
CONCLUSION
Metformin use appeared to be associated with a lower risk of death in patients with diabetes hospitalised for COVID-19.
目的
二甲双胍具有抗炎和免疫抑制作用。我们研究了既往使用二甲双胍对因 COVID-19 住院的 2 型糖尿病患者预后的影响。
方法
CORONADO 是一项全国性观察性研究，纳入 2020 年 3 月 10 日至 4 月 10 日期间在法国 68 个中心因 COVID-19 住院的糖尿病患者。主要结局是入院后 7 天内气管插管和/或死亡的复合结局。Kaplan-Meier 生存曲线用于报告至第 28 天的死亡情况。然后，采用倾向评分逆概率治疗加权法，在 logistic 回归分析中估计二甲双胍使用与结局的相关性。
结果
在纳入的 2449 例患者中，1496 例为二甲双胍使用者，953 例为非使用者。与非使用者相比，二甲双胍使用者年龄较小，糖尿病并发症发生率较低，但入院时 COVID-19 特征更严重。主要终点在二甲双胍使用者中第 7 天发生 28.0%（vs 非使用者 29.0%，P=0.6134），第 28 天发生 32.6%（vs 非使用者 38.7%，P=0.0023）。第 7 天和第 28 天，二甲双胍使用者的死亡率较低，分别为 8.2%（vs 16.1%，P<0.0001）和 16.0%（vs 28.6%，P<0.0001）。在进行倾向评分加权后，第 7 天和第 28 天的主要结局和死亡的优势比（95%CI）分别为二甲双胍使用者与非使用者 0.838[0.649-1.082]和 0.688[0.470-1.007]，0.783[0.615-0.996]和 0.710[0.537-0.938]。
结论
在因 COVID-19 住院的糖尿病患者中，二甲双胍的使用与较低的死亡风险相关。
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