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. 2022 Jan;5(1):e00301.
doi: 10.1002/edm2.301. Epub 2021 Sep 29.

Inpatient use of metformin and acarbose is associated with reduced mortality of COVID-19 patients with type 2 diabetes mellitus

Jinghong Li  1 , Qi Wei  2 , Karen C McCowen  1 , Wei Xiong  2 , Jiao Liu  2 , Wenlijun Jiang  2 , Robert L Thomas  1 , Mark Hepokoski  1 , Ming He  1 , John Y J Shyy  1 , Atul Malhotra  1 , Nian Xiong  2   3 , Willis X Li  1
Affiliations

Inpatient use of metformin and acarbose is associated with reduced mortality of COVID-19 patients with type 2 diabetes mellitus

Jinghong Li et al. Endocrinol Diabetes Metab. 2022 Jan.

Abstract

Aims: 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. The current study aims 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.

Methods: We continue to carry out a retrospective analysis of a cohort of 131 patients with T2DM hospitalized for COVID-19 and treated with different combinations of diabetes medications.

Results: We found that patients using metformin (p = .02) and acarbose (p = .04), alone or both together (p = .03), after admission were significantly more likely to survive than those who did not use either metformin or acarbose. 37 patients continued to take metformin after admission and 35 (94.6%) survived. Among the 57 patients who used acarbose after admission, 52 survived (91.2%). A total of 20 patients used both metformin and acarbose, while 57 used neither. Of the 20 dual-use patients, 19 (95.0%) survived.

Conclusion: Our analyses suggest that inpatient use of metformin and acarbose together or alone during hospitalization should be studied in randomized trials.

Keywords: acarbose; coronavirus disease 2019 (COVID-19); insulin; metformin; sulfonylureas; type 2 diabetes mellitus (T2DM).

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Conflict of interest statement

Dr. Malhotra reports income from Equillium, Corvus and Livanova related to medical education. ResMed provided a philanthropic donation to UC San Diego.

Figures

FIGURE 1
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, as previously shown 6 ) 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
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