Inpatient Use of Metformin and Acarbose Is Associated with Reduced Mortality of COVID-19 Patients with Type 2 Diabetes Mellitus

Abstract

Type 2 diabetes mellitus (T2DM) is a strong risk factor for complications of coronavirus disease 2019 (COVID-19). The effect of T2DM medications on COVID-19 outcomes remains unclear. In a retrospective analysis of a cohort of 131 patients with T2DM hospitalized for COVID-19 in Wuhan, we have previously found that metformin use prior to hospitalization is associated with reduced mortality. Here we continue to investigate the effects of inpatient use of T2DM medications, including metformin, acarbose, insulin, and sulfonylureas, on the mortality of COVID-19 patients with T2DM during hospitalization. We found that patients using metformin and acarbose, alone or both together, after admission were significantly more likely to survive than those who did not use either metformin or acarbose. Thus, our analyses suggest that inpatient use of metformin and acarbose together or alone during hospitalization should be studied in randomized trials.

Figure 1

Diabetes medications and effects on survival COVID-19 patients with T2DM. (A, B) The Venn diagrams show the number of patients taking different diabetes medications before (A) and after (B) admission into the hospital. (C, D) Kaplan-Meier curves show survival probabilities for patients on different combinations of metformin and acarbose before (C) and after (D) admission. P-values indicate differences among the 4 groups by log rank statistics. (E, F) Kaplan-Meier curves show survival probabilities for patients on one or more diabetes medications vs those not on any of the four diabetes medications before (E) and after (F) admission.