Table 2 How notable studies reported the association of glucose-lowering drug classes with different outcomes in Covid-19
From: The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence?
Study | Metformin | SGLT2 inhibitors | GLP-1 RA | DPP-4 inhibitors | Insulin |
|---|---|---|---|---|---|
~ 3 million patients with type 2 diabetes, including ~ 13,500 who died due to Covid-19, in a UK nationwide population cohort [23] | Covid-19 mortality less likely vs no metformin | Covid-19 mortality less likely vs no SGLT2i | No significant difference in Covid-19 mortality vs no GLP-1 RA | Covid-19 mortality more likely vs no DPP-4i | Covid-19 mortality more likely vs no insulin |
~ 12,500 patients with a positive Covid-19 test in a US longitudinal cohort (N3C) [88] | Not investigated | Lower rates of 60-day mortality, ER visits and hospitalization vs DPP-4i | Lower rates of 60-day mortality, ER visits and hospitalization vs DPP-4i | 60-day mortality, ER visits and hospitalization more likely vs SGLT2i or GLP-1 RA | Not investigated |
1970 people on GLP-1 RA, SGLT2i or DPP-4i in nationwide registries in Denmark who were infected with Covid-19 [95] | Not investigated | No significant differences to GLP-1 RA or DPP-4i, but a trend towards reduced 30-day mortality vs DPP-4i | No significant difference to SGLT2i | A non-significant trend towards increased 30-day mortality vs SGLT2i | Not investigated |
2666 patients with type 2 diabetes in a nationwide Covid-19 registry in Spain (SEMI-COVID-19) [121] | No significant differences after propensity matching | Not investigated | Not investigated | No significant differences after propensity matching | No significant differences after propensity matching |
2796 patients with diabetes hospitalized for Covid-19 in a nationwide study in France (CORONADO) [10, 82, 96] | 28-day mortality less likely vs insulin or no metformin | Not investigated | Not investigated | Neutral effect vs patients not on DPP-4i [96] | 28-day mortality more likely vs metformin |
~ 25,000 patients on SGLT2i or DPP-4i in UK primary care [122] | Not investigated | Similar likelihood of Covid-19 onset vs DPP-4i | Not investigated | Similar likelihood of Covid-19 onset vs SGLT2i | Not investigated |
Randomized control trial of dapagliflozin vs placebo in 1250 patients hospitalized with Covid-19 (DARE-19) [106] | Not investigated | No significant difference but trend towards reduced organ failure and death vs placebo | Not investigated | Not investigated | Not investigated |
8121 patients hospitalized for Covid‐19 in a meta-analysis of five studies [123] | Mortality less likely vs no metformin | Not investigated | Not investigated | Not investigated | Not investigated |
7008 patients with Covid‐19 and diabetes in a meta-analysis of nine studies [83] | Not investigated | Not investigated | Not investigated | In-hospital administration associated with reduced mortality vs no DPP-4i, but overall neutral effect | Not investigated |
6256 patients with type 2 diabetes in a US claims database [79] | Mortality less likely vs no metformin (in women only) | Not investigated | Not investigated | Not investigated | Not investigated |