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Review
. 2021 Nov;58(11):1441-1450.
doi: 10.1007/s00592-021-01739-1. Epub 2021 Jun 25.

Managing diabetes in diabetic patients with COVID: where do we start from?

Angelo Avogaro  1 , Benedetta Bonora  2 , Gian Paolo Fadini  2
Affiliations
Review

Managing diabetes in diabetic patients with COVID: where do we start from?

Angelo Avogaro et al. Acta Diabetol. 2021 Nov.

Abstract

Aims: COVID-19 has and still is sweeping away the national health systems worldwide. In this review, we sought to determine the evidence base proofs on the antidiabetic treatment capable to reduce the risk of COVID-19-related mortality.

Methods: We have performed a systematic search of published articles using PubMed, and EMBASE from March 2020 to March 31st, 2021. We excluded editorials, commentary, letters to the editor, reviews, and studies that did not have mortality as an outcome. For metformin and insulin only, we performed a meta-analysis using Cochrane RevMan 5.2.

Results: Among antidiabetic drugs, metformin was the only drug associated with a reduced risk of mortality. Conversely, insulin appears associated with an increased risk. The other classes of drugs were neutral.

Conclusions: The totality of articles reports retrospective data strongly affected by "channeling bias" so that most of the existing results on each class of drugs are driven by the phenotype of patients likely to receive that specific drug by prescription.

Keywords: COVID-19; Diabetes mellitus; Diabetes treatment; Metformin; SARS-CoV-2; Type 2.

PubMed Disclaimer

Conflict of interest statement

BMB received lecture or advisory board fees from Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Mundipharma, Novartis, Novo Nordisk, and Sanofi. AA received research grants, lecture or advisory board fees from: Merck Sharp & Dome, AstraZeneca, Novartis, Boehringer-Ingelheim, Sanofi, Mediolanum, Janssen, Novo Nordisk, Lilly, Servier, and Takeda. GPF received grants, honoraria or lecture fees from Abbott, Astrazeneca, Boehringer, Lilly, Novo Nordisk, Sanofi.

Figures

Fig. 1
Fig. 1
Risk for mortality for metformin users and other glucose-lowering medication users. Risk ratio with 95% confidence intervals
Fig. 2
Fig. 2
Risk for mortality for metformin users and other glucose-lowering medication users in studies with (top panel) and without (propensity score matching). Risk ratio with 95% confidence intervals
Fig. 3
Fig. 3
Risk for mortality for insulin users and other glucose-lowering medication users. Risk ratio with 95% confidence intervals
Fig. 4
Fig. 4
Treatment approaches to patients with diabetes and COVID-19
See this image and copyright information in PMC

Comment in

  • Insulin therapy in patients with COVID-19.
    Kow CS, Ramachandram DS, Hasan SS. Kow CS, et al. Acta Diabetol. 2022 Feb;59(2):285-286. doi: 10.1007/s00592-021-01810-x. Epub 2021 Oct 14. Acta Diabetol. 2022. PMID: 34648089 Free PMC article. No abstract available.

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