Division for Health Informatics and Biostatistics, Department for Biostatistics, Croatian Institute of Public Health, Zagreb, Croatia.
Health Center "Dom zdravlja Zagreb zapad", Zagreb, Croatia.
PLoS One. 2024 Mar 27;19(3):e0301056. doi: 10.1371/journal.pone.0301056. eCollection 2024.
Patients with diabetes mellitus type 2 and chronic kidney disease (T2DM-CKD) have a 5 times higher risk of developing severe SARS-CoV-2 infection than those without these 2 diseases. The goal of this study is to provide information on T2DM-CKD and COVID-19 outcomes, with an emphasis on the association with anti-diabetic medications.
Study is designed as a retrospective cohort analysis covering the years 2020 and 2021. Data from the National Diabetes Registry (CroDiab) were linked to hospital data, primary healthcare data, Causes of Death Registry data, the SARS-CoV-2 vaccination database, and the SARS-CoV-2 test results database. Study outcomes were cumulative incidence of SARS-CoV-2 positivity, COVID-19 hospitalizations, and COVID-19 deaths. For outcome predictors, logistic regression models were developed.
Of 231 796 patients with diabetes mellitus type 2 in the database, 7 539 were T2DM-CKD (3.25%). The 2-year cumulative incidences of all three studies' outcomes were higher in T2DM-CKD than in diabetes patients without CKD (positivity 18.1% vs. 14.4%; hospitalization 9.7% vs. 4.2%; death 3.3% vs. 1.1%, all p<0.001). For COVID-19 hospitalization, protective factors were SGLT-2 inhibitors use (OR 0.430; 95%CI 0.257-0.719) and metformin use (OR 0.769; 95% CI 0.643-0.920), risk factors were insulin use (1.411; 95%CI 1.167-1.706) and sulfonylureas use (OR 1.226; 95% CI 1.027-1.464). For SARS-CoV-2 positivity protective factors were SGLT-2 inhibitors (0.607; 95% CI 0.448-0.823), repaglinide use (OR 0.765; 95% CI 0.593-0.986) and metformin use (OR 0.857; 95% CI 0.770-0.994). DPP-4 inhibitors showed a non-significant decrease in risk for COVID-19 death (OR 0.761; 95% CI 0.568-1.019).
T2DM-CKD are heavily burdened by COVID-19 disease. Our results suggest no association between antidiabetic drugs and COVID-19 death outcome while SGLT-2 and metformin show to be protective against COVID-19 hospitalization and infection, repaglinide against infection, and insulin and sulfonylureas show to be risk factors for COVID-19 hospitalization and infection. Further research in T2DM-CKD is needed.
患有 2 型糖尿病和慢性肾病（T2DM-CKD）的患者感染严重严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的风险比没有这两种疾病的患者高 5 倍。本研究的目的是提供 T2DM-CKD 和 COVID-19 结局的信息，重点是与抗糖尿病药物的关系。
本研究设计为回顾性队列分析，涵盖 2020 年和 2021 年。国家糖尿病登记处（CroDiab）的数据与医院数据、初级保健数据、死因登记处数据、SARS-CoV-2 疫苗数据库和 SARS-CoV-2 检测结果数据库相关联。研究结果为 SARS-CoV-2 阳性的累积发生率、COVID-19 住院和 COVID-19 死亡。对于结局预测因素，开发了逻辑回归模型。
数据库中共有 231796 名 2 型糖尿病患者，其中 7539 名为 T2DM-CKD（3.25%）。在这三项研究的两年累积发生率中，T2DM-CKD 的所有结果均高于无 CKD 的糖尿病患者（阳性率为 18.1%比 14.4%；住院率为 9.7%比 4.2%；死亡率为 3.3%比 1.1%，均<0.001）。对于 COVID-19 住院，保护因素是 SGLT-2 抑制剂的使用（OR 0.430；95%CI 0.257-0.719）和二甲双胍的使用（OR 0.769；95%CI 0.643-0.920），危险因素是胰岛素的使用（1.411；95%CI 1.167-1.706）和磺脲类药物的使用（OR 1.226；95%CI 1.027-1.464）。对于 SARS-CoV-2 阳性，保护因素是 SGLT-2 抑制剂（0.607；95%CI 0.448-0.823）、瑞格列奈的使用（OR 0.765；95%CI 0.593-0.986）和二甲双胍的使用（OR 0.857；95%CI 0.770-0.994）。DPP-4 抑制剂对 COVID-19 死亡的风险呈非显著降低（OR 0.761；95%CI 0.568-1.019）。
T2DM-CKD 患者深受 COVID-19 疾病的困扰。我们的研究结果表明，抗糖尿病药物与 COVID-19 死亡结局之间没有关联，而 SGLT-2 和二甲双胍可预防 COVID-19 住院和感染，瑞格列奈可预防感染，胰岛素和磺脲类药物可增加 COVID-19 住院和感染的风险。需要对 T2DM-CKD 进行进一步的研究。
