Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19 |
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| Authors: | Jean-Daniel Lalau Abdallah Al-Salameh Samy Hadjadj Thomas Goronflot Nicolas Wiernsperger Matthieu Pichelin Ingrid Allix Coralie Amadou Olivier Bourron Thierry Duriez Jean-François Gautier Anne Dutour Céline Gonfroy Didier Gouet Michael Joubert Ingrid Julier Etienne Larger Lucien Marchand Bertrand Cariou |
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| Affiliation: | 1. Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, 80054 Amiens, France;2. PériTox = UMR_I 01, University of Picardie Jules Verne, Amiens, France;3. Département d’Endocrinologie, Diabétologie et Nutrition, l''institut du Thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093 Nantes Cedex 01, France;4. Data Clinic, INSERM, CIC 1413, PHU 11, Nantes University Hospital, Nantes, France;5. Association REMEDES, Ville-sur-Jarnioux, France;6. Département d’Endocrinologie, Diabétologie, Nutrition, CHU Angers, Angers, France;7. Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonne, France;8. Sorbonne Université, Assistance Publique Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié Salpêtrière-Charles Foix, Inserm, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06, Institute of Cardiometabolism and Nutrition ICAN, Paris, France;9. Service D’Endocrinologie, Diabétologie, CH Cholet, Cholet, France;10. Département Diabète et Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France;11. Département d’Endocrinologie et de Diabétologie, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France;12. Service d’Endocrinologie, Diabétologie, CH de Pontoise, Pontoise, France;13. Service de Diabétologie, Endocrinologie, Centre Hospitalier de la Rochelle, La Rochelle, France;14. Service Diabétologie-endocrinologie, CHU Caen, Caen, France;15. CH de Ales, Ales, France;p. Université de Paris and AP-HP, Centre Hospitalier Universitaire de Paris, Cochin Hospital, Paris, France;q. Département d’Endocrinologie et de Diabétologie, Centre Hospitalier St. Joseph - St. Luc, Lyon, France;r. Clinique Ambroise Paré Neuilly-sur-Seine, Centre de Recherches des Cordelier, Université Paris Diderot, Paris, France;s. Service d’Endocrinologie, Diabète et Nutrition, HUS - Hôpital Civil, Strasbourg, France;t. Service de Diabétologie, Centre Hospitalier de Cahors, Cahors, France;u. Département d’Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Rouen, Université de Rouen, Rouen, France;v. CHU de Brest, Brest, France;w. CH Robet Boulin de Libourne, Libourne, France;x. Département d’Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Centre de Recherche des Cordeliers, Inserm, U-1138, Université de Paris, Paris, France;y. Centre d’Investigation Clinique CIC 1402, Université de Poitiers, Inserm, CHU de Poitiers, Poitiers, France;z. Service de Diabétologie, CH Gonesse, Gonesse, France;11. Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Laboratoire CarMeN, Inserm, INRA, INSA, Université Claude Bernard Lyon 1, Lyon, France;22. Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Paris, France;33. Département d’Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, Université de Toulouse, Toulouse, France |
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| Abstract: | AimsMetformin exerts anti-inflammatory and immunosuppressive effects. We addressed the impact of prior metformin use on prognosis in patients with type 2 diabetes hospitalised for COVID-19.MethodsCORONADO is a nationwide observational study that included patients with diabetes hospitalised for COVID-19 between March 10 and April 10, 2020 in 68 French centres. The primary outcome combined tracheal intubation and/or death within 7 days of admission. A Kaplan-Meier survival curve was reported for death up to day 28. The association between metformin use and outcomes was then estimated in a logistic regression analysis after applying a propensity score inverse probability of treatment weighting approach.ResultsAmong the 2449 patients included, 1496 were metformin users and 953 were not. Compared with non-users, metformin users were younger with a lower prevalence of diabetic complications, but had more severe features of COVID-19 on admission. The primary endpoint occurred in 28.0% of metformin users (vs 29.0% in non-users, P = 0.6134) on day 7 and in 32.6% (vs 38.7%, P = 0.0023) on day 28. The mortality rate was lower in metformin users on day 7 (8.2 vs 16.1%, P < 0.0001) and on day 28 (16.0 vs 28.6%, P < 0.0001). After propensity score weighting was applied, the odds ratios for primary outcome and death (OR [95%CI], metformin users vs non-users) were 0.838 [0.649?1.082] and 0.688 [0.470?1.007] on day 7, then 0.783 [0.615?0.996] and 0.710 [0.537?0.938] on day 28, respectively.ConclusionMetformin use appeared to be associated with a lower risk of death in patients with diabetes hospitalised for COVID-19. |
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| Keywords: | COVID-19 Death Mechanical ventilation Metformin Propensity score Type 2 diabetes |
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