在糖尿病成人中普遍使用二甲双胍与长新冠的发病率：来自 RECOVER 计划的基于电子健康记录的队列研究。
Prevalent Metformin Use in Adults With Diabetes and the Incidence of Long COVID: An EHR-Based Cohort Study From the RECOVER Program.
机构信息
Institute for Health Informatics, University of Minnesota, Minneapolis, MN.
Information Technologies and Services Department, Weill Cornell Medicine, New York, NY.
出版信息
Diabetes Care. 2024 Nov 1;47(11):1930-1940. doi: 10.2337/DCa24-0032.
OBJECTIVE
Studies show metformin use before and during SARS-CoV-2 infection reduces severe COVID-19 and postacute sequelae of SARS-CoV-2 (PASC) in adults. Our objective was to describe the incidence of PASC and possible associations with prevalent metformin use in adults with type 2 diabetes mellitus (T2DM).
RESEARCH DESIGN AND METHODS
This is a retrospective cohort analysis using the National COVID Cohort Collaborative (N3C) and Patient-Centered Clinical Research Network (PCORnet) electronic health record (EHR) databases with an active comparator design that examined metformin-exposed individuals versus nonmetformin-exposed individuals who were taking other diabetes medications. T2DM was defined by HbA1c ≥6.5 or T2DM EHR diagnosis code. The outcome was death or PASC within 6 months, defined by EHR code or computable phenotype.
RESULTS
In the N3C, the hazard ratio (HR) for death or PASC with a U09.9 diagnosis code (PASC-U09.0) was 0.79 (95% CI 0.71-0.88; P < 0.001), and for death or N3C computable phenotype PASC (PASC-N3C) was 0.85 (95% CI 0.78-0.92; P < 0.001). In PCORnet, the HR for death or PASC-U09.9 was 0.87 (95% CI 0.66-1.14; P = 0.08), and for death or PCORnet computable phenotype PASC (PASC-PCORnet) was 1.04 (95% CI 0.97-1.11; P = 0.58). Incident PASC by diagnosis code was 1.6% metformin vs. 2.0% comparator in the N3C, and 2.1% metformin vs. 2.5% comparator in PCORnet. By computable phenotype, incidence was 4.8% metformin and 5.2% comparator in the N3C and 24.7% metformin vs. 26.1% comparator in PCORnet.
CONCLUSIONS
Prevalent metformin use is associated with a slightly lower incidence of death or PASC after SARS-CoV-2 infection. PASC incidence by computable phenotype is higher than by EHR code, especially in PCORnet. These data are consistent with other observational analyses showing prevalent metformin is associated with favorable outcomes after SARS-CoV-2 infection in adults with T2DM.
目的
研究表明，在感染 SARS-CoV-2 之前和期间使用二甲双胍可降低成年人中严重 COVID-19 和 SARS-CoV-2 的急性后遗症（PASC）。我们的目的是描述 PASC 的发生率，并探讨其与 2 型糖尿病（T2DM）成年患者中普遍使用二甲双胍的可能关联。
研究设计和方法
这是一项使用全国 COVID 队列协作（N3C）和以患者为中心的临床研究网络（PCORnet）电子健康记录（EHR）数据库的回顾性队列分析，采用活性对照设计，比较暴露于二甲双胍的个体与服用其他糖尿病药物的非二甲双胍暴露个体。T2DM 通过 HbA1c≥6.5 或 T2DM EHR 诊断代码定义。结局为 6 个月内死亡或 PASC，通过 EHR 代码或可计算表型定义。
结果
在 N3C 中，U09.9 诊断代码（PASC-U09.0）的死亡或 PASC 的风险比（HR）为 0.79（95%CI 0.71-0.88；P<0.001），而 N3C 可计算表型的死亡或 PASC-N3C 为 0.85（95%CI 0.78-0.92；P<0.001）。在 PCORnet 中，U09.9 的死亡或 PASC-U09.9 的 HR 为 0.87（95%CI 0.66-1.14；P=0.08），而 PCORnet 可计算表型的死亡或 PASC-PCORnet 为 1.04（95%CI 0.97-1.11；P=0.58）。N3C 中二甲双胍的 PASC 发生率为 1.6%，而对照组为 2.0%，PCORnet 中二甲双胍的 PASC 发生率为 2.1%，而对照组为 2.5%。通过可计算表型，N3C 中二甲双胍的发生率为 4.8%，对照组为 5.2%，PCORnet 中二甲双胍的发生率为 24.7%，对照组为 26.1%。
结论
普遍使用二甲双胍与 SARS-CoV-2 感染后死亡或 PASC 的发生率略有降低相关。通过可计算表型的 PASC 发生率高于通过 EHR 代码的发生率，尤其是在 PCORnet 中。这些数据与其他观察性分析结果一致，表明在患有 T2DM 的成年人中，普遍使用二甲双胍与 SARS-CoV-2 感染后的良好结局相关。
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