Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England

Cohort study (2,851,465 people with diabetes) describes adjusted HRs for COVID-19 related deaths for recorded vs no recorded prescription for various classes of glucose lowering treatment. There were differences in risk, but there is no clear indication to change prescribing

SPS commentary:

The HRs for COVID-19 related mortality for people with diabetes for recorded vs no recorded prescription were: 0.77 (95% CI 0.73–0.81) for metformin, 1·42 (1·35–1·49) for insulin, 0·75 (0·48–1·17) for meglitinides, 0·82 (0·74–0·91) for SGLT2 inhibitors, 0·94 (0·82–1·07) for thiazolidinediones, 0·94 (0·89–0·99) for sulfonylureas, 0·94 (0·83–1·07) for GLP-1 receptor agonists, 1·07 (1·01–1·13) for DPP-4 inhibitors, and 1·26 (0·76–2·09) for α-glucosidase inhibitors.

Authors highlight findings are likely to be due to confounding by indication, in view of the use of different drug classes at different stages of type 2 diabetes disease progression.

A commentary piece notes that because of the limitations of real-world studies, prospective randomised clinical trials are necessary to more meaningfully explore which glucose-lowering agents, if any, induce benefit or harm in patients with COVID-19. Irrespective of therapy choice, strict management of cardiovascular risk factors and tight glycaemic control are crucial for patients with diabetes and COVID-19

Source:

The Lancet Diabetes & Endocrinology

Resource links:

Commentary