Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 19;11(2):270.
doi: 10.3390/pathogens11020270.

Patients with Obesity and a History of Metformin Treatment Have Lower Influenza Mortality: A Retrospective Cohort Study

Tammy H Cummings  1   2 , Joseph Magagnoli  1   2 , James W Hardin  1   3 , S Scott Sutton  1   2
Affiliations

Patients with Obesity and a History of Metformin Treatment Have Lower Influenza Mortality: A Retrospective Cohort Study

Tammy H Cummings et al. Pathogens. .

Abstract

Background: Obesity is a risk factor for the development of influenza by leading to a chronic inflammatory state and T-cell dysfunction. Based upon preclinical research, metformin has influenza activity by restoring T-cell function and improving the immune response.

Objective: We aimed to evaluate the potential drug repurposing of metformin for the management of influenza among patients with obesity utilizing national claims data in an electronic health record database.

Methods: The VA Informatics and Computing Infrastructure (VINCI) was utilized to obtain individual-level information on demographics, administrative claims, and pharmacy dispensation. A cohort was created among individuals with laboratory confirmed diagnosis of influenza with a diagnosis of fever, cough, influenza, or acute upper respiratory infection in an outpatient setting. The study outcome was death after diagnosis of influenza. Cohorts were formed using diabetes status and metformin exposure prior to a positive influenza diagnosis. Hazard ratios for mortality were estimated using a cox proportional hazards model adjusting for baseline covariates and a sub-analysis was conducted utilizing propensity score matching. A greedy nearest neighbor algorithm was utilized to match 1 to 1 non-metformin diabetic controls and non-diabetic controls to diabetic patients receiving metformin.

Results: A total of 3551 patients met the inclusion criteria and were evaluated in our study. The cohorts consisted of 1461 patients in the non-diabetic cohort, 1597 patients in the diabetic / metformin cohort, and 493 patients in the diabetic no metformin cohort. Compared to non-diabetic patients, diabetic patients with metformin had a lower rate of death (aHR 0.78, 95% CI 0.609-0.999). There was not a statistical difference between the non-diabetic patients and the diabetic patients without metformin (aHR 1.046, 95% CI 0.781-1.400). The propensity score matched cohorts revealed consistent results with the primary analysis.

Conclusion: Our results demonstrated patients with obesity and a history of metformin treatment have lower influenza mortality.

Keywords: T-cell restoration; drug repurposing; influenza; metformin; obesity.

PubMed Disclaimer

Conflict of interest statement

S.S.S., T.H.C, and J.M. receive support from the National Institutes of Health (NIH) grant R01DA054992 and the South Carolina Center for Rural and Primary Healthcare unrelated to this work. S.S.S. has received research grants from Boehringer Ingelheim, Gilead Sciences, Alexion Pharmaceuticals, and United Therapeutics unrelated to this work. The other authors declare no competing interests.

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization Global influenza strategy 2019–2030. 2019. [(accessed on 26 January 2022)]. Available online: https://apps.who.int/iris/handle/10665/311184.
    1. CDC Pandemic Basics. [(accessed on 26 January 2022)];2017 Available online: https://www.cdc.gov/flu/pandemic-resources/basics/faq.html.
    1. Morgan O.W., Bramley A., Fowlkes A., Freedman D.S., Taylor T.H., Gargiullo P., Belay B., Jain S., Cox C., Kamimoto L., et al. Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS ONE. 2010;5:e9694. doi: 10.1371/journal.pone.0009694. - DOI - PMC - PubMed
    1. Louie J.K., Acosta M., Samuel M.C., Schechter R., Vugia D.J., Harriman K., Matyas B.T. A novel risk factor for a novel virus: Obesity and 2009 pandemic influenza a (H1N1) Clin. Infect. Dis. 2011;52:301–312. doi: 10.1093/cid/ciq152. - DOI - PubMed
    1. Neidich S.D., Green W.D., Rebeles J., Karlsson E.A., Schultz-Cherry S., Noah T.L., Chakladar S., Hudgens M.G., Weir S.S., Beck M.A. Increased risk of influenza among vaccinated adults who are obese. Int. J. Obes. 2017;41:1324–1330. doi: 10.1038/ijo.2017.131. - DOI - PMC - PubMed

LinkOut - more resources