Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals/Queens, New York City, New York, USA.
Department of Diabetes & Endocrinology, GD Hospital & Diabetes Institute, Kolkata, India.
J Diabetes. 2023 Feb;15(2):86-96. doi: 10.1111/1753-0407.13359. Epub 2023 Jan 23.
Patients with diabetes are more likely to suffer COVID-19 complications. Using noninsulin antihyperglycemic medications (AGMs) during COVID-19 infection has proved challenging. In this study, we evaluate different noninsulin AGMs in patients with COVID-19.
We searched Medline, Embase, Web of Science, and Cochrane on 24 January 2022. We used the following keywords (COVID-19) AND (diabetes mellitus) AND (antihyperglycemic agent). The inclusion criteria were studies reporting one or more of the outcomes. We excluded non-English articles, case reports, and literature reviews. Study outcomes were mortality, hospitalization, and intensive care unit (ICU) admission.
The use of metformin rather than other glucose-lowering medications was associated with statistically significant lower mortality (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.47, 0.77, p < .001). Dipeptidyl peptidase-4 inhibitor (DPP-4i) use was associated with statistically significantly higher hospitalization risk (RR: 1.44, 95% CI: 1.23, 1.68, p < .001) and higher risk of ICU admissions and/or mechanical ventilation vs nonusers (RR: 1.24, 95% CI: 1.04, 1.48, p < .02). There was a statistically significant decrease in hospitalization for SGLT-2i users vs nonusers (RR: 0.89, 95% CI: 0.84-0.95, p < .001). Glucagon-like peptide-1 receptor agonist (GLP-1RA) use was associated with a statistically significant decrease in mortality (RR: 0.56, 95% CI: 0.42, 073, p < 0.001), ICU admission, and/or mechanical ventilation (RR: 0.79, 95% CI: 0.69-0.89, p < .001), and hospitalization (RR: 0.73, 95% CI: 0.54, 0.98, p = .04).
AGM use was not associated with increased mortality. However, metformin and GLP-1RA use reduced mortality risk statistically significantly. DPP-4i use was associated with a statistically significant increase in the risk of hospitalization and admission to the ICU.
患有糖尿病的患者更有可能患上 COVID-19 并发症。在 COVID-19 感染期间使用非胰岛素类降血糖药物（AGM）具有挑战性。在这项研究中，我们评估了 COVID-19 患者使用不同的非胰岛素类 AGM。
我们于 2022 年 1 月 24 日在 Medline、Embase、Web of Science 和 Cochrane 上进行了搜索。我们使用了以下关键字（COVID-19）和（糖尿病）和（抗高血糖药）。纳入标准是报告一个或多个结局的研究。我们排除了非英语文章、病例报告和文献综述。研究结局是死亡率、住院率和重症监护病房（ICU）入住率。
与其他降糖药物相比，使用二甲双胍而非其他降糖药物与死亡率显著降低相关（风险比 [RR]：0.60，95%置信区间 [CI]：0.47，0.77，p<.001）。二肽基肽酶-4 抑制剂（DPP-4i）的使用与统计学上显著更高的住院风险相关（RR：1.44，95%CI：1.23，1.68，p<.001），与 ICU 入院和/或机械通气的风险更高相关与非使用者相比（RR：1.24，95%CI：1.04，1.48，p<.02）。与非使用者相比，使用 SGLT-2i 的住院率有统计学显著降低（RR：0.89，95%CI：0.84-0.95，p<.001）。使用胰高血糖素样肽-1 受体激动剂（GLP-1RA）与死亡率显著降低相关（RR：0.56，95%CI：0.42，0.73，p<.001），与 ICU 入院和/或机械通气相关（RR：0.79，95%CI：0.69-0.89，p<.001），以及住院（RR：0.73，95%CI：0.54，0.98，p=.04）。
AGM 的使用与死亡率增加无关。然而，二甲双胍和 GLP-1RA 的使用显著降低了死亡风险。DPP-4i 的使用与住院和 ICU 入院风险的统计学显著增加相关。
