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. 2021 Mar;45(2):251-259.
doi: 10.4093/dmj.2020.0206. Epub 2021 Mar 5.

Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19

Sang Youl Rhee  1 , Jeongwoo Lee  2 , Hyewon Nam  2 , Dae-Sung Kyoung  2 , Dong Wook Shin  3 , Dae Jung Kim  4
Affiliations

Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19

Sang Youl Rhee et al. Diabetes Metab J. 2021 Mar.

Abstract

Background: Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM).

Methods: As of May 2020, analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Insurance Review and Assessment Service (HIRA) database in Korea. Using this dataset, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Additionally, we validated the results using the National Health Insurance Service (NHIS) of Korea dataset.

Results: Totally, data of 67,850 subjects were accessible in the HIRA dataset. Of these, 5,080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 (95% confidence interval [CI], 0.135 to 0.971), and that for RAS blockade users was 0.599 (95% CI, 0.251 to 1.431). These findings were consistent with the analysis based on the NHIS data using 704 final subjects. The adjusted odds ratio for severe treatment among DPP-4i users was 0.303 (95% CI, 0.135 to 0.682), and that for RAS blockade users was 0.811 (95% CI, 0.391 to 1.682).

Conclusion: This study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19.

Keywords: Angiotensin-converting enzyme 2; COVID-19; COVID-19 drug treatment; Diabetes mellitus; Dipeptidyl peptidase 4.

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Conflict of interest statement

CONFLICTS OF INTEREST

Researchers from a pharmaceutical company participated in this study (Jeongwoo Lee, Hyewon Nam, and Dae-Sung Kyoung). They are experts on claims data, and their institutions have not intentionally influenced the basic hypothesis of the study, analysis plan, result arrangement, result interpretation, and manuscript preparation. The researchers from other institutions have no conflict of interest to declare.

Figures

Fig. 1.
Fig. 1.
Flow chart of the selection of study subjects based on the data from the National Health Insurance Review and Assessment Service of Korea. COVID-19, coronavirus disease 2019; DM, diabetes mellitus; ICU, intensive care unit.
Fig. 2.
Fig. 2.
Flow chart of the selection of study subjects based on the National Health Information Database (NHID)-COVID database from the National Health Insurance service of Korea. COVID-19, coronavirus disease 2019; DM, diabetes mellitus; ICU, intensive care unit.
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References

    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–20. - PMC - PubMed
    1. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55:2000547. - PMC - PubMed
    1. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020;36:e3319 - PMC - PubMed
    1. Rhee EJ, Kim JH, Moon SJ, Lee WY. Encountering COVID-19 as endocrinologists. Endocrinol Metab (Seoul) 2020;35:197–205. - PMC - PubMed
    1. Won KC, Yoon KH. The outbreak of COVID-19 and diabetes in Korea: “we will find a way as we have always done”. Diabetes Metab J. 2020;44:211–2. - PMC - PubMed

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