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. 2021 Jan 13:11:600439.
doi: 10.3389/fendo.2020.600439. eCollection 2020.

Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes

Andrew B Crouse  1 , Tiffany Grimes  2 , Peng Li  3 , Matthew Might  1 , Fernando Ovalle  2 , Anath Shalev  2
Affiliations

Metformin Use Is Associated With Reduced Mortality in a Diverse Population With COVID-19 and Diabetes

Andrew B Crouse et al. Front Endocrinol (Lausanne). .

Abstract

Background: Coronavirus disease-2019 (COVID-19) is a growing pandemic with an increasing death toll that has been linked to various comorbidities as well as racial disparity. However, the specific characteristics of these at-risk populations are still not known and approaches to lower mortality are lacking.

Methods: We conducted a retrospective electronic health record data analysis of 25,326 subjects tested for COVID-19 between 2/25/20 and 6/22/20 at the University of Alabama at Birmingham Hospital, a tertiary health care center in the racially diverse Southern U.S. The primary outcome was mortality in COVID-19-positive subjects and the association with subject characteristics and comorbidities was analyzed using simple and multiple linear logistic regression.

Results: The odds ratio of contracting COVID-19 was disproportionately high in Blacks/African-Americans (OR 2.6; 95% CI 2.19-3.10; p<0.0001) and in subjects with obesity (OR 1.93; 95% CI 1.64-2.28; p<0.0001), hypertension (OR 2.46; 95% CI 2.07-2.93; p<0.0001), and diabetes (OR 2.11; 95% CI 1.78-2.48; p<0.0001). Diabetes was also associated with a dramatic increase in mortality (OR 3.62; 95% CI 2.11-6.2; p<0.0001) and emerged as an independent risk factor in this diverse population even after correcting for age, race, sex, obesity, and hypertension. Interestingly, we found that metformin treatment prior to diagnosis of COVID-19 was independently associated with a significant reduction in mortality in subjects with diabetes and COVID-19 (OR 0.33; 95% CI 0.13-0.84; p=0.0210).

Conclusion: Thus, these results suggest that while diabetes is an independent risk factor for COVID-19-related mortality, this risk is dramatically reduced in subjects taking metformin prior to diagnosis of COVID-19, raising the possibility that metformin may provide a protective approach in this high risk population.

Keywords: African-American; coronavirus disease-2019; diabetes; metformin; mortality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Forest plot showing adjusted mortality risk in subjects with coronavirus 2019 (COVID-19). Multiple logistic regression analysis with age, race, sex, obese status, hypertension status, and diabetes status as covariates was performed. The regression yielded a significant model (p<0.0001) with AUC of 0.79 (95% CI 0.74–0.85) and the adjusted odds ratios (OR), 95% confidence intervals (LCL-UCL) and corresponding P-values are shown.
Figure 2
Figure 2
Forest plot showing adjusted mortality risk in subjects with coronavirus 2019 (COVID-19) and T2D. Multiple logistic regression analysis with metformin use, insulin use, age, race, sex, obese status, and hypertension status as covariates was performed and yielded a significant model (p=0.0001) with AUC of 0.77 (0.69, 0.85). The adjusted odds ratios (OR), 95% confidence intervals (LCL-UCL), and corresponding P-values are shown.
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