Is Metformin Use Associated with a More Favorable COVID-19 Course in People with Diabetes?

Area of Science:

• * Infectious Diseases
• * Endocrinology
• * Clinical Pharmacology

Background:

• * Diabetes Mellitus (DM) is linked to increased Coronavirus disease-19 (COVID-19) mortality.
• * Observational studies suggest a potential benefit of metformin in COVID-19 prognosis, but findings are conflicting.

Purpose of the Study:

• * To investigate the effect of metformin on in-hospital mortality among patients with DM and COVID-19.
• * To adjust for confounding factors influencing COVID-19 outcomes in diabetic patients.

Main Methods:

• * Retrospective study of 524 SARS-CoV-2-positive patients with DM admitted to two Italian hospitals.
• * Binomial logistic regression analysis was used to assess mortality and need for ventilation.
• * COVID-19 Mortality Risk Score (MRS) was employed as a covariate for confounder adjustment.

Main Results:

• * Overall in-hospital mortality was 33.4%.
• * Initial analysis indicated metformin use was associated with reduced case fatality (OR 0.67 [0.45-0.98], p = 0.039).
• * After adjusting for COVID-19 MRS, metformin was no longer significantly associated with reduced in-hospital mortality (OR 0.795 [0.495-1.277], p = 0.342).

Conclusions:

• * The study did not prove a beneficial effect of metformin on COVID-19 prognosis in diabetic patients after accounting for confounding variables.
• * Validated risk stratification tools like COVID-19 MRS are crucial for evaluating medication and comorbidity effects on COVID-19 outcomes.