Diabetes medications unlikely to greatly influence COVID-19 mortality risk
medwireNews: Research shows that COVID-19 mortality risk in people with type 2 diabetes varies only a little according to which antiglycemic medications they are taking at the time.
And the researchers believe these small differences between classes “are likely to be due to confounding by indication, in view of the use of different drug classes in the early and late stages of the type 2 diabetes disease trajectory.”
The study, published in The Lancet Diabetes & Endocrinology, included data from 2,851,465 people with type 2 diabetes, identified in the National Diabetes Audit of England.
By linking these data to hospital records and death registrations, Kamlesh Khunti (Leicester General Hospital, UK) and colleagues found that 0.5% of the cohort had died between February and August 2020 with COVID-19 listed as the primary or secondary cause of death. This amounted to a COVID-19–related mortality rate of 8.9 per 1000 person–years.
“In view of the disproportionately high contribution of people with diabetes to overall COVID-19-related deaths (up to a third of all deaths in some countries), the relation between glucose-lowering drugs and COVID-19 is an important issue for people with diabetes, clinicians, and policy makers,” say the researchers.
After adjusting for baseline characteristics, the team found some variation in COVID-19 mortality risk according to which class of diabetes medications people had been prescribed.
Specifically, taking metformin, sodium-glucose cotransporter (SGLT)2 inhibitors, or sulfonylureas was associated with a significantly reduced risk, with reductions ranging from 6% to 23% versus not taking that medication class.
Use of glucagon-like peptide-1 receptor agonists, α-glucosidase inhibitors, or meglitinides had no association with COVID-19 mortality risk, whereas use of dipeptidyl peptidase (DPP)-4 inhibitors or insulin was associated with an increased risk, of 7% and 42%, respectively.
“We interpret these findings to suggest that there is, as yet, no clear indication to jeopardise a modifiable risk factor—glucose control—or other potential glucose-independent benefits of specific drugs by stopping or changing diabetes medications in people with type 2 diabetes in daily practice,” conclude the researchers.
The author of a linked commentary, Guntram Schernthaner (Rudolfstiftung Hospital Vienna, Austria), agrees with their view that residual confounding underlies the observed differences in mortality risk, noting for example that people taking a DPP-4 inhibitor were more likely to be older than 70 years and have reduced kidney function than those taking an SGLT2 inhibitor.
Considering the evidence to date, he suggests that “recommendations on the use of glucose-lowering drugs by people with type 2 diabetes during the COVID-19 pandemic might now become more liberal, allowing use of all glucose-lowering drugs in stable situations.”
But Schernthaner stresses: “Irrespective of therapy choice, strict management of cardiovascular risk factors and tight glycaemic control are crucial for patients with diabetes and COVID-19.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
1 April 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.