Metformin use may lower risk for long COVID in adults with type 2 diabetes
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Key takeaways:
- Metformin use was tied to a lower risk for long COVID than other diabetes medications among adults with type 2 diabetes.
- The reduced risk was only observed in the National COVID Cohort Collaborative database.
Adults with type 2 diabetes using metformin before or during a SARS-CoV-2 infection may have a lower risk for long COVID than those using other diabetes medications, according to findings published in Diabetes Care.
“In this retrospective cohort study in adults with type 2 diabetes and prevalent diabetes medication use, there is evidence that prevalent metformin use is associated with a slightly lower incidence of death or postacute sequelae of SARS-CoV-2 infection,” Steven G. Johnson, PhD, assistant professor and director of the division for informatics innovation dissemination at the Institute for Health Informatics – University of Minnesota, and colleagues wrote. “Prevalent user analyses of diabetes medications in adults with type 2 diabetes may give little insight into decision making at the time of SARS-CoV-2 infection, but these data support a mildly beneficial role of metformin on chronic SARS-CoV-2 outcomes in people with diabetes.”
In a retrospective study funded by the NIH, researchers analyzed electronic health record data from the National COVID Cohort Collaborative and the National Patient-Centered Clinical Research Network of adults aged 21 years and older with type 2 diabetes who had a positive SARS-CoV-2 test from March 2020 to November 2022. Researchers identified diagnoses of postacute sequelae of SARS-CoV-2 infection within 180 days of a positive test using two methods. The first method identified long COVID through ICD-10 codes, whereas the second method used a computable phenotype. For the National COVID Cohort Collaborative database, the computable phenotype was identified using a machine learning model trained on ICD-10 codes and other factors and identified long COVID as any adult having a postacute sequelae of SARS-CoV-2 infection probability of more than 75%. For the National Patient-Centered Clinical Research Network database, postacute sequelae of SARS-CoV-2 infection was defined as a new diagnosis of one of 25 different conditions 30 to 180 days after COVID-19. Adults with type 2 diabetes who used metformin were compared with adults who did not use metformin but had a prescription for another noninsulin diabetes drug.
There were 51,385 adults from the National COVID Cohort Collaborative and 37,947 adults from the National Patient-Centered Clinical Research Network included in the study. In the National COVID Cohort Collaborative group, 1.7% had a diagnostic code for postacute sequelae of SARS-CoV-2 infection, 4.9% had a phenotype for postacute sequelae of SARS-CoV-2 infection and 4.2% died. Among the National Patient-Centered Clinical Research Network group, 1.3% had an ICD-10 code for postacute sequelae of SARS-CoV-2 infection, 25% had postacute sequelae of SARS-CoV-2 infection as identified through a computable phenotype and 4% died.
“The incidence of postacute sequelae of SARS-CoV-2 was lower when defined by ICD code compared to a computable phenotype in both databases,” the researchers wrote. “This may reflect the challenges of clinical care for adults needing chronic medication management and the likelihood of those adults receiving a formal postacute sequelae of SARS-CoV-2 diagnosis.”
After inverse probability of treatment weighting, 1.6% of adults using metformin in the National COVID Cohort Collaborative had an ICD-10 diagnosis for long COVID compared with 2% of those not using metformin. When the computable phenotype definition was used, 4.8% of those using metformin had long COVID vs. 5.2% of those using other diabetes medications.
Among the National Patient-Centered Clinical Research Network group, the prevalence of postacute sequelae of SARS-CoV-2 was 2.2% for adults using metformin and 2.6% for those using another diabetes medication. When the computable phenotype definition was used, the prevalence of postacute sequelae of SARS-CoV-2 was 25.2% for those using metformin and 24.2% for adults using other diabetes medications.
In the National COVID Cohort Collaborative, adults using metformin had a lower risk for postacute sequelae of SARS-CoV-2 or death than those using other diabetes medications both when using ICD-10 codes (HR = 0.79; 95% CI, 0.71-0.88; P < .001) or the computable phenotype (HR = 0.85; 95% CI, 0.78-0.92; P < .001). In the National Patient-Centered Clinical Research Network, no significant difference for risk of postacute sequelae of SARS-CoV-2 or death was observed between adults using metformin and those using other diabetes medications.
The researchers wrote that future studies should examine the effects of starting metformin at or after a SARS-CoV-2 infection to assess whether it could be a possible treatment for the disease.
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