Scheen A J, Paquot N
Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Belgique.
Rev Med Liege. 2021 Mar;76(3):152-155.
Both obesity and type 2 diabetes (T2D) are recognized risk factors for developing a more severe form of COVID-19, with a higher death rate. Metformin is considered as the first-line medication for the treatment of T2D, especially in obese patients. Beyond its glucose-lowering activity, metformin exerts pleiotropic effects, among which an anti-inflammatory effect that could be beneficial. However, metformin is contraindicated in case of severe renal insufficiency, liver failure and/or unstable heart failure, because of a risk of lactic acidosis. Yet, COVID-19, besides the well-known pneumonia that can be responsible for severe hypoxemia, may be associated with multisystemic organ failure, among which kidneys, liver and heart. Thus, the question arises whether metformin, which represents the background therapy in above 80 % of patients with T2D, should be continued in patients exposed to SARS-CoV-2 or instead be stopped. This article summarizes the most important results of observational studies, which all argue for a beneficial effect of metformin therapy that is associated with a significant reduction in mortality among hospitalized patients with T2D due to COVID-19. Finally, some practical advices will be given.
肥胖和2型糖尿病（T2D）均被认为是罹患更严重形式的COVID-19且死亡率更高的风险因素。二甲双胍被视为治疗T2D的一线药物，尤其是在肥胖患者中。除了其降糖活性外，二甲双胍还具有多种效应，其中一种抗炎效应可能是有益的。然而，由于存在乳酸酸中毒风险，在严重肾功能不全、肝功能衰竭和/或不稳定心力衰竭的情况下，二甲双胍是禁忌使用的。然而，COVID-19除了可导致严重低氧血症的众所周知的肺炎外，还可能与多系统器官衰竭相关，其中包括肾脏、肝脏和心脏。因此，问题就出现了，对于超过80%的T2D患者作为基础治疗药物的二甲双胍，在接触SARS-CoV-2的患者中是应该继续使用还是停用。本文总结了观察性研究的最重要结果，所有这些结果都支持二甲双胍治疗的有益效果，这与因COVID-19住院的T2D患者死亡率显著降低相关。最后，将给出一些实用建议。
