Effects of pre-existing metformin therapy on platelet count, serum creatinine, and hospitalization in COVID-19 patients with diabetes mellitus

Archana M Navale; Vanila Devangan; Arpit Goswami; Vikas Sahu; Lavanya S; Devanshu Patel; Archana M Navale; Vanila Devangan; Arpit Goswami; Vikas Sahu; Lavanya S; Devanshu Patel

doi:10.3934/molsci.2023018

AIMS Molecular Science

2023, Volume 10, Issue 4: 311-321. doi: 10.3934/molsci.2023018

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Research article

Effects of pre-existing metformin therapy on platelet count, serum creatinine, and hospitalization in COVID-19 patients with diabetes mellitus

1.
Department of Pharmacology, Parul Institute of Pharmacy, Parul University, Limda, Gujarat, India
2.
Department of Pharmacy Practice, Parul Institute of Pharmacy, Parul University, Limda, Gujarat, India
3.
Department of Pharmacy Practice, PSG College of Pharmacy Practice, Peelamedu, Coimbatore, TN 641 004, India
4.
Department of Pharmacology, Parul Institute of Medical Science and Research, Gujarat, Parul University, Limda, Vadodara, India

Received: 09 September 2023 Revised: 29 November 2023 Accepted: 11 December 2023 Published: 25 December 2023

COVID-19 infected individuals with type 2 diabetes mellitus are at higher risk of COVID-19 related complications. Previous studies have yielded varying results regarding the effect of metformin, an antidiabetic drug, on the clinical outcomes of COVID-19 patients. In this retrospective observational study, we aim to assess the impact of pre-existing oral antidiabetic treatment on the clinical outcomes of COVID-19.

We analyzed in-patient data from hospital records, enrolling 150 COVID-19 patients with pre-existing diabetes mellitus. Among them, 75 were treated with metformin, while the remaining 75 were not. Exclusion criteria included patients with type I diabetes mellitus and those above 85 years of age. Fisher's exact test, Chi square test and unpaired t-test were used to analyze the data. There were no significant differences between the two groups in terms of age, gender, or drugs prescribed, aside from metformin. However, the metformin-treated group exhibited a significantly higher proportion of moderately ill patients compared to the non-metformin-treated group (P = 0.0011). Nonetheless, no statistically significant differences were observed between the groups regarding oxygen support requirement or duration of hospital stay. Notably, the metformin group showed distinct variations in haematological parameters, including lower serum creatinine levels (P = 0.0049), platelet count (P = 0.02) and HbA1c levels (P = 0.01). In conclusion, pre-existing metformin treatment did not impact the duration of hospital stay or the need for oxygen support in COVID-19 patients. However, the treatment did exert influence on other essential parameters.
- COVID-19,
- metformin,
- oral antidiabetic treatment,
- diabetes mellitus,
- therapeutic outcome,
- HbA1c
Citation: Archana M Navale, Vanila Devangan, Arpit Goswami, Vikas Sahu, Lavanya S, Devanshu Patel. Effects of pre-existing metformin therapy on platelet count, serum creatinine, and hospitalization in COVID-19 patients with diabetes mellitus[J]. AIMS Molecular Science, 2023, 10(4): 311-321. doi: 10.3934/molsci.2023018

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Abstract

COVID-19 infected individuals with type 2 diabetes mellitus are at higher risk of COVID-19 related complications. Previous studies have yielded varying results regarding the effect of metformin, an antidiabetic drug, on the clinical outcomes of COVID-19 patients. In this retrospective observational study, we aim to assess the impact of pre-existing oral antidiabetic treatment on the clinical outcomes of COVID-19.

We analyzed in-patient data from hospital records, enrolling 150 COVID-19 patients with pre-existing diabetes mellitus. Among them, 75 were treated with metformin, while the remaining 75 were not. Exclusion criteria included patients with type I diabetes mellitus and those above 85 years of age. Fisher's exact test, Chi square test and unpaired t-test were used to analyze the data. There were no significant differences between the two groups in terms of age, gender, or drugs prescribed, aside from metformin. However, the metformin-treated group exhibited a significantly higher proportion of moderately ill patients compared to the non-metformin-treated group (P = 0.0011). Nonetheless, no statistically significant differences were observed between the groups regarding oxygen support requirement or duration of hospital stay. Notably, the metformin group showed distinct variations in haematological parameters, including lower serum creatinine levels (P = 0.0049), platelet count (P = 0.02) and HbA1c levels (P = 0.01). In conclusion, pre-existing metformin treatment did not impact the duration of hospital stay or the need for oxygen support in COVID-19 patients. However, the treatment did exert influence on other essential parameters.

Conflicts of interest

All authors declare no conflicts of interest in this paper.

References

[1]	World Health OrganizationIndia country overview (2020). Available from: https://www.who.int/countries/ind
[2]	Apicella M, Campopiano MC, Mantuano M, et al. (2020) COVID-19 in people with diabetes: Understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol 8: 782-792. https://doi.org/10.1016/S2213-8587(20)30238-2
[3]	Lim S, Bae JH, Kwon HS, Nauck MA (2021) COVID-19 and diabetes mellitus: From pathophysiology to clinical management. Nat Rev Endocrinol 17: 11-30. https://doi.org/10.1038/s41574-020-00435-4
[4]	Cheng X, Liu YM, Li H, et al. (2020) Metformin is associated with higher incidence of acidosis, but not mortality, in individuals with COVID-19 and pre-existing type 2 diabetes. Cell Metab 32: 537-547. https://doi.org/10.1016/j.cmet.2020.08.013
[5]	Gao Y, Liu T, Zhong W, et al. (2020) Risk of metformin in patients with type 2 diabetes with COVID-19: A preliminary retrospective report. Clin Transl Sci 13: 1055-1059. https://doi.org/10.1111/cts.12897
[6]	Pérez-Belmonte LM, Torres-Peña JD, López-Carmona MD, et al. (2020) Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: A nationwide cohort study. BMC Med 18: 359. https://doi.org/10.1186/s12916-020-01832-2
[7]	Wang J, Cooper JM, Gokhale K, et al. (2021) Association of metformin with susceptibility to COVID-19 in people with type 2 diabetes. J Clin Endocrinol Metab 106: 1255-1268. https://doi.org/10.1210/clinem/dgab067
[8]	Nafakhi H, Alareedh M, Al-Buthabhak K, et al. (2021) Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq. Diabetes Metab Syndr 15: 33-38. https://doi.org/10.1016/j.dsx.2020.12.014
[9]	Luo P, Qiu L, Liu Y, et al. (2020) Metformin treatment was associated with decreased mortality in COVID-19 patients with diabetes in a retrospective analysis. Am J Trop Med Hyg 103: 69-72. https://doi.org/10.4269/ajtmh.20-0375
[10]	Wargny M, Potier L, Gourdy P, et al. (2021) Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: Updated results from the nationwide CORONADO study. Diabetologia 64: 778-794. https://doi.org/10.1007/s00125-020-05351-w
[11]	Bramante CT, Ingraham NE, Murray TA, et al. (2020) Metformin and risk of mortality in patients hospitalised with COVID-19: A retrospective cohort analysis. Lancet Healthy Longev 2: e34-e41. https://doi.org/10.1016/S2666-7568(20)30033-7
[12]	Li J, Wei Q, McCowen KC, et al. (2022) Inpatient use of metformin and acarbose is associated with reduced mortality of COVID-19 patients with type 2 diabetes mellitus. Endocrinol Diabetes Metab 5: e00301. https://doi.org/10.1002/edm2.301
[13]	Mendy A, Gopal R, Alcorn JF, et al. (2019) Reduced mortality from lower respiratory tract disease in adult patients with diabetes treated with metformin. Respirology 24: 646-651. https://doi.org/10.1111/resp.13486
[14]	Varghese E, Samuel SM, Liskova A, et al. (2021) Diabetes and coronavirus (SARS-CoV-2): molecular mechanism of metformin intervention and the scientific basis of drug repurposing. PLoS Pathog 17: e1009634. https://doi.org/10.1371/journal.ppat.1009634
[15]	Diagnosis and treatment protocol for novel coronavirus pneumonia (Trial version 7)Chin Med J (Engl) (2020)133: 1087-1095. https://doi.org/10.1097/CM9.0000000000000819
[16]	Alkundi A, Mahmoud I, Musa A, et al. (2020) Clinical characteristics and outcomes of COVID-19 hospitalized patients with diabetes in the United Kingdom: A retrospective single centre study. Diabetes Res Clin Pract 165: 108263. https://doi.org/10.1016/j.diabres.2020.108263
[17]	Sharma S, Ray A, Sadasivam B (2020) Metformin in COVID-19: A possible role beyond diabetes. Diabetes Res Clin Pract 164: 108183. https://doi.org/10.1016/j.diabres.2020.108183
[18]	Isoda K, Young JL, Zirlik A, et al. (2006) Metformin inhibits proinflammatory responses and nuclear factor-κB in human vascular wall cells. Arterioscler Thromb Vasc Biol 26: 611-617. https://doi.org/10.1161/01.ATV.0000201938.78044.75
[19]	Scheen AJ (2020) Metformin and COVID-19: From cellular mechanisms to reduced mortality. Diabetes Metab 46: 423-426. https://doi.org/10.1016/j.diabet.2020.07.006
[20]	Samuel SM, Varghese E, Büsselberg D (2021) Therapeutic potential of metformin in COVID-19: Reasoning for its protective role. Trends Microbiol 29: 894-907. https://doi.org/10.1016/j.tim.2021.03.004
[21]	Xin G, Wei Z, Ji C, et al. (2016) Metformin uniquely prevents thrombosis by inhibiting platelet activation and mtDNA release. Sci Rep 6: 36222. https://doi.org/10.1038/srep36222
[22]	Cheng X, Xin S, Chen Y, et al. (2021) Effects of metformin, insulin on COVID-19 patients with pre-existed type 2 diabetes: A multicentral retrospective study. Life Sci 275: 119371. https://doi.org/10.1016/j.lfs.2021.119371
[23]	Mrozikiewicz-Rakowska B, Bałut D, Bąk PM, et al. (2021) The phenomenon of metformin in COVID-19 pandemic among Polish patients with type 2 diabetes mellitus. Am Heart J 242: 173. https://doi.org/10.1016/j.ahj.2021.10.068
[24]	Ravindran S, Kuruvilla V, Wilbur K, et al. (2017) Nephroprotective effects of metformin in diabetic nephropathy. J Cell Physiol 232: 731-742. https://doi.org/10.1002/jcp.25598
[25]	Bai B, Chen H (2021) Metformin: A novel weapon against inflammation. Front Pharmacol 12: 622262. https://doi.org/10.3389/fphar.2021.622262
[26]	Chen Y, Yang D, Cheng B, et al. (2020) Clinical characteristics and outcomes of patients with diabetes and COVID-19 in association with glucose-lowering medication. Diabetes Care 43: 1399-1407. https://doi.org/10.2337/dc20-0660
[27]	Varghese E, Samuel SM, Liskova A, et al. (2021) Diabetes and coronavirus (SARS-CoV-2): Molecular mechanism of Metformin intervention and the scientific basis of drug repurposing. PLoS Pathog 17: e1009634. https://doi.org/10.1371/journal.ppat.1009634

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