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Managing diabetes in diabetic patients with COVID: where do we start from?

Angelo Avogaro1, Benedetta Bonora2, Gian Paolo Fadini2

  • 1Department of Medicine, Unit of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padova, Italy. angelo.avogaro@unipd.it.

Acta Diabetologica
|June 26, 2021
PubMed
Abstract

Insights

Metformin may reduce mortality risk in patients with diabetes during the COVID-19 pandemic. However, insulin might increase this risk, though data is limited by channeling bias in retrospective studies.

Area of Science:

  • Endocrinology
  • Infectious Diseases
  • Pharmacology

Background:

  • The COVID-19 pandemic has overwhelmed global healthcare systems.
  • Understanding the impact of antidiabetic treatments on COVID-19 outcomes is crucial.

Purpose of the Study:

  • To review evidence on antidiabetic treatments and their association with COVID-19 mortality.
  • To identify specific antidiabetic drugs that may mitigate or exacerbate mortality risk.

Main Methods:

  • Systematic literature search of PubMed and EMBASE (March 2020 - March 2021).
  • Inclusion of studies with mortality as an outcome; exclusion of non-original research.
  • Meta-analysis for metformin and insulin using Cochrane RevMan 5.2.

Main Results:

  • Metformin was the only antidiabetic drug associated with a reduced risk of COVID-19-related mortality.
  • Insulin use appeared linked to an increased risk of mortality.
  • Other antidiabetic drug classes showed neutral associations with mortality.

Conclusions:

  • Existing evidence is largely retrospective and subject to significant channeling bias.
  • Patient phenotype influences the prescription of specific antidiabetic drugs, potentially confounding mortality results.
  • Further research is needed to clarify the true impact of antidiabetic treatments on COVID-19 mortality.
Keywords:
COVID-19Diabetes mellitusDiabetes treatmentMetforminSARS-CoV-2Type 2

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