Abstract
Objectives: To investigate the association between baseline use of glucose-lowering drugs and serious clinical outcome among patients with type 2 diabetes.
Design: Territory-wide retrospective cohort of confirmed cases of COVID-19 between January 2020 and February 2021.
Setting: All public health facilities in Hong Kong.
Participants: 1220 patients with diabetes who were admitted for confirmed COVID-19.
Primary and secondary outcome measures: Composite clinical endpoint of intensive care unit admission, requirement of invasive mechanical ventilation and/or in-hospital death.
Results: In this cohort (median age 65.3 years, 54.3% men), 737 (60.4%) patients were treated with metformin, 385 (31.6%) with sulphonylureas, 199 (16.3%) with dipeptidyl peptidase-4 (DPP-4) inhibitors and 273 (22.4%) with insulin prior to admission. In multivariate Cox regression, use of metformin and DPP-4 inhibitors was associated with reduced incidence of the composite endpoint relative to non-use, with respective HRs of 0.51 (95% CI 0.34 to 0.77, p=0.001) and 0.46 (95% CI 0.29 to 0.71, p<0.001), adjusted for age, sex, diabetes duration, glycated haemoglobin (HbA1c), smoking, comorbidities and drugs. Use of sulphonylureas (HR 1.55, 95% CI 1.07 to 2.24, p=0.022) and insulin (HR 6.34, 95% CI 3.72 to 10.78, p<0.001) were both associated with increased hazards of the composite endpoint.
Conclusions: Users of metformin and DPP-4 inhibitors had fewer adverse outcomes from COVID-19 compared with non-users, whereas insulin and sulphonylurea might predict a worse prognosis.
Keywords: COVID-19; diabetes & endocrinology.
【저자키워드】 COVID-19, diabetes &, endocrinology., 【초록키워드】 public health, intensive care, Comorbidities, drugs, Comorbidity, Sex, diabetes, smoking, inhibitors, type 2 diabetes, Clinical outcome, Dipeptidyl peptidase-4, adverse outcome, metformin, endocrinology, Haemoglobin, Cohort, Patient, age, incidence, Hong Kong, inhibitor, insulin, Admission, predict, Glucose, association, intensive care unit admission, Invasive mechanical ventilation, Cox regression, Composite, composite endpoint, health facilities, In-hospital death, confirmed case, user, Endpoint, 95% CI, confirmed cases, median age, hazard, multivariate Cox regression, worse prognosis, multivariate, secondary outcome, dipeptidyl peptidase, retrospective cohort, Glucose-lowering drug, men, reduced, treated, adjusted, diabete, baseline, patients with diabete, 【제목키워드】 drug, outcome, Patient, Analysis, type 2 diabete,