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18-02-2021 | Diabetes | News | Article

Metformin among factors linked to favorable COVID-19 outcomes

Author:
Eleanor McDermid

medwireNews: The latest report from the CORONADO study reveals factors predictive of home discharge within 28 days among people with diabetes hospitalized with COVID-19, as well as those linked to mortality risk.

“In addition to data on in-hospital death, we believe data on home discharge within 28 days should be reported since it is a positive result of value for both patients and physicians and it provides another perspective on COVID-19,” write the investigators in Diabetologia.

A previous report from the multicenter French CORONADO study identified high BMI as a key factor associated with mortality risk within 7 days of hospitalization.

The latest analysis involves a larger number of patients (n=2796), with follow-up to 28 days. They were an average age of 69.7 years, and 36.3% were women.

Half (50.2%) of these patients were discharged home within 28 days of admission. In multivariate analyses, younger age was strongly associated with an increased likelihood of discharge, as was a longer duration of symptoms prior to admission.

In addition, metformin use was associated with a significant 40% increased likelihood of discharge, in line with a recent study suggesting a protective effect of the medication against mortality, although only in women.

Around one in five (20.6%) people died by day 28, with deaths being fairly evenly divided between the first 7 days (11.2%) and days 8–28 (9.5%). Factors predictive of discharge were also associated with an increased likelihood of survival at 28 days.

Variables significantly associated with 28-day mortality risk were having microvascular complications of diabetes, being on anticoagulant treatment at baseline, and having dyspnea. Also, higher levels of liver enzymes, white blood cells, and C-reactive protein – all reflecting more severe COVID-19 – were associated with mortality risk.

Glycated hemoglobin (HbA1c) was not associated with outcomes, and neither were other comorbidities including macrovascular complications. By contrast with the previous publication, BMI was not predictive of mortality.

However, the researchers point to the findings from the OpenSAFELY study, which demonstrated increased mortality risk with high BMI and a “clearly graded effect” of HbA1c in data from more than 10,000 deaths related to COVID-19, and highlight the comparatively “more limited dataset” of the CORONADO study.

Baseline insulin use was associated with a significantly increased 28-day mortality risk, as was use of a statin, which the researchers say is “surprising since the in-hospital use of this drug class has been recently associated with a lower risk of 28-day mortality in 13,981 patients with COVID-19 from China.”

They say it is not clear whether the associations with pre-existing treatments represent “a significant negative effect or a mere indication bias” and that the statistical analyses needed to give a clearer idea are “beyond the scope of the current paper.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

18 February 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.

Diabetologia 2021; doi:10.1007/s00125-020-05351-w

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