Poly Tahmina Nasrin, Islam Md Mohaimenul, Li Yu-Chuan Jack, Lin Ming-Chin, Hsu Min-Huei, Wang Yao-Chin
Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110301, Taiwan.
International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei 110301, Taiwan.
J Clin Med. 2021 Aug 9;10(16):3507. doi: 10.3390/jcm10163507.
The coronavirus disease 2019 (COVID-19) increases hyperinflammatory state, leading to acute lung damage, hyperglycemia, vascular endothelial damage, and a higher mortality rate. Metformin is a first-line treatment for type 2 diabetes and is known to have anti-inflammatory and immunosuppressive effects. Previous studies have shown that metformin use is associated with decreased risk of mortality among patients with COVID-19; however, the results are still inconclusive. This study investigated the association between metformin and the risk of mortality among diabetes patients with COVID-19.
Data were collected from online databases such as PubMed, EMBASE, Scopus, and Web of Science, and reference from the most relevant articles. The search and collection of relevant articles was carried out between 1 February 2020, and 20 June 2021. Two independent reviewers extracted information from selected studies. The random-effects model was used to estimate risk ratios (RRs), with a 95% confidence interval.
A total of 16 studies met all inclusion criteria. Diabetes patients given metformin had a significantly reduced risk of mortality (RR, 0.65; 95% CI: 0.54-0.80, < 0.001, heterogeneity I = 75.88, Q = 62.20, and τ = 0.06, < 0.001) compared with those who were not given metformin. Subgroup analyses showed that the beneficial effect of metformin was higher in the patients from North America (RR, 0.43; 95% CI: 0.26-0.72, = 0.001, heterogeneity I = 85.57, Q = 34.65, τ = 0.31) than in patients from Europe (RR, 0.67; 95% CI: 0.47-0.94, = 0.02, heterogeneity I = 82.69, Q = 23.11, τ = 0.10) and Asia (RR, 0.90; 95% CI: 0.43-1.86, = 0.78, heterogeneity I = 64.12, Q = 11.15, τ = 0.40).
This meta-analysis shows evidence that supports the theory that the use of metformin is associated with a decreased risk of mortality among diabetes patients with COVID-19. Randomized control trials with a higher number of participants are warranted to assess the effectiveness of metformin for reducing the mortality of COVID-19 patients.
2019年冠状病毒病（COVID-19）会加剧炎症状态，导致急性肺损伤、高血糖、血管内皮损伤以及更高的死亡率。二甲双胍是2型糖尿病的一线治疗药物，已知具有抗炎和免疫抑制作用。先前的研究表明，使用二甲双胍与COVID-19患者死亡率降低有关；然而，结果仍不明确。本研究调查了二甲双胍与COVID-19糖尿病患者死亡率风险之间的关联。
从PubMed、EMBASE、Scopus和Web of Science等在线数据库收集数据，并参考最相关文章的参考文献。在2020年2月1日至2021年6月20日期间进行相关文章的检索和收集。两名独立评审员从选定的研究中提取信息。采用随机效应模型估计风险比（RRs），并给出95%置信区间。
共有16项研究符合所有纳入标准。与未使用二甲双胍的糖尿病患者相比，使用二甲双胍的糖尿病患者死亡率风险显著降低（RR，0.65；95%置信区间：0.54 - 0.80，< 0.001，异质性I = 75.88，Q = 62.20，τ = 0.06，< 0.001）。亚组分析显示，二甲双胍对北美患者（RR，0.43；95%置信区间：0.26 - 0.72，= 0.001，异质性I = 85.57，Q = 34.65，τ = 0.31）的有益作用高于欧洲患者（RR，0.67；95%置信区间：0.47 - 0.94，= 0.02，异质性I = 82.69，Q = 23.11，τ = 0.10）和亚洲患者（RR，0.90；95%置信区间：0.43 - 1.86，= 0.78，异质性I = 64.12，Q = 11.15，τ = 0.40）。
这项荟萃分析显示了支持如下理论的证据，即使用二甲双胍与COVID-19糖尿病患者死亡率风险降低有关。有必要开展更多参与者的随机对照试验，以评估二甲双胍降低COVID-19患者死亡率的有效性。
