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Observational Study
. 2021 Sep;47(5):101216.
doi: 10.1016/j.diabet.2020.101216. Epub 2020 Dec 10.

Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19

Jean-Daniel Lalau  1 , Abdallah Al-Salameh  2 , Samy Hadjadj  3 , Thomas Goronflot  4 , Nicolas Wiernsperger  5 , Matthieu Pichelin  3 , Ingrid Allix  6 , Coralie Amadou  7 , Olivier Bourron  8 , Thierry Duriez  9 , Jean-François Gautier  10 , Anne Dutour  11 , Céline Gonfroy  12 , Didier Gouet  13 , Michael Joubert  14 , Ingrid Julier  15 , Etienne Larger  16 , Lucien Marchand  17 , Michel Marre  18 , Laurent Meyer  19 , Frédérique Olivier  20 , Gaëtan Prevost  21 , Pascale Quiniou  22 , Christelle Raffaitin-Cardin  23 , Ronan Roussel  24 , Pierre-Jean Saulnier  25 , Dominique Seret-Begue  26 , Charles Thivolet  27 , Camille Vatier  28 , Rachel Desailloud  29 , Matthieu Wargny  4 , Pierre Gourdy  30 , Bertrand Cariou  3 ; CORONADO investigators
Affiliations
Observational Study

Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19

Jean-Daniel Lalau et al. Diabetes Metab. 2021 Sep.

Abstract

Aims: Metformin exerts anti-inflammatory and immunosuppressive effects. We addressed the impact of prior metformin use on prognosis in patients with type 2 diabetes hospitalised for COVID-19.

Methods: CORONADO is a nationwide observational study that included patients with diabetes hospitalised for COVID-19 between March 10 and April 10, 2020 in 68 French centres. The primary outcome combined tracheal intubation and/or death within 7 days of admission. A Kaplan-Meier survival curve was reported for death up to day 28. The association between metformin use and outcomes was then estimated in a logistic regression analysis after applying a propensity score inverse probability of treatment weighting approach.

Results: Among the 2449 patients included, 1496 were metformin users and 953 were not. Compared with non-users, metformin users were younger with a lower prevalence of diabetic complications, but had more severe features of COVID-19 on admission. The primary endpoint occurred in 28.0% of metformin users (vs 29.0% in non-users, P = 0.6134) on day 7 and in 32.6% (vs 38.7%, P = 0.0023) on day 28. The mortality rate was lower in metformin users on day 7 (8.2 vs 16.1%, P < 0.0001) and on day 28 (16.0 vs 28.6%, P < 0.0001). After propensity score weighting was applied, the odds ratios for primary outcome and death (OR [95%CI], metformin users vs non-users) were 0.838 [0.649-1.082] and 0.688 [0.470-1.007] on day 7, then 0.783 [0.615-0.996] and 0.710 [0.537-0.938] on day 28, respectively.

Conclusion: Metformin use appeared to be associated with a lower risk of death in patients with diabetes hospitalised for COVID-19.

Keywords: COVID-19; Death; Mechanical ventilation; Metformin; Propensity score; Type 2 diabetes.

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Figures

Fig. 1
Fig. 1
Flow chart of the study population showing the total population of the CORONADO study, the main reasons for exclusion from the present analysis and the main time points of the study.
Fig. 2
Fig. 2
Kaplan-Meier survival curves showing the non-adjusted survival from hospital admission up to day 28 according to treatment with metformin.
See this image and copyright information in PMC

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