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
Source:
The Lancet Diabetes & Endocrinology
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