Metformin Use Is Associated with Increased Incidence of Acidosis but not Mortality in Individuals with COVID-19 and Pre-existing Type 2 Diabetes

Cheng, Xu; Liu, Ye-Mao; Li, Haomiao; Zhang, Xin; Lei, Fang; Qin, Juan-Juan; Chen, Ze; Deng, Ke-Qiong; Lin, Lijin; Chen, Ming-Ming; Song, Xiaohui; Xia, Meng; Huang, Xuewei; Liu, Weifang; Cai, Jingjing; Zhang, Xiao-Jing; Zhou, Feng; Zhang, Peng; Wang, Yibin; Ma, Xinliang; Xu, Qingbo; Yang, Juan; Ye, Ping; Mao, Weiming; Huang, Xiaodong; Xia, Jiahong; Zhang, Bing-Hong; Guo, Jiao; Zhu, Lihua; Lu, Zhibing; Yuan, Yufeng; Wei, Xiang; She, Zhi-Gang; Ji, Yan-Xiao; Li, Hongliang

Summary The safety and efficacy of anti-diabetic drugs are critical for maximizing the benefical impacts of well-controlled blood glucose on the prognosis of individuals with COVID-19 and pre-existing type 2 diabetes (T2D). Metformin is the most commonly prescribed first-line medication for T2D, but its impact on the outcomes of individuals with COVID-19 and T2D remains to be clarified. Our current retrospective study in a cohort of 1,213 hospitalized individuals with COVID-19 and pre-existing T2D indicated that metformin use was significantly associated with a higher incidence of acidosis, particularly in cases with severe COVID-19, but not with 28-day COVID-19-related mortality. Furthermore, metformin use was significantly associated with reduced heart failure and inflammation. Our findings provide clinical evidence in support of continuing metformin treatment in individuals with COVID-19 and pre-existing T2D, but acidosis and kidney function should be carefully monitored in individuals with severe COVID-19.