Therapeutic Potential of Metformin in COVID-19: Reasoning for Its Protective Role

Trends Microbiol. 2021 Oct;29(10):894-907. doi: 10.1016/j.tim.2021.03.004. Epub 2021 Mar 14.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections present with increased disease severity and poor clinical outcomes in diabetic patients compared with their nondiabetic counterparts. Diabetes/hyperglycemia-triggered endothelial dysfunction and hyperactive inflammatory and immune responses are correlated to twofold to threefold higher intensive care hospitalizations and more than twice the mortality among diabetic coronavirus disease 2019 (COVID-19) patients. While comorbidities such as obesity, cardiovascular disease, and hypertension worsen the prognosis of diabetic COVID-19 patients, COVID-19 infections are also associated with new-onset diabetes, severe metabolic complications, and increased thrombotic events in the backdrop of aberrant endothelial function. While several antidiabetic medications are used to manage blood glucose levels, we discuss the multifaceted ability of metformin to control blood glucose levels and possibly attenuate endothelial dysfunction, inhibit viral entry and infection, and modify inflammatory and immune responses during SARS-CoV-2 infections. These actions make metformin a viable candidate drug to be considered for repurposing and gaining ground against the SARS-CoV-2-induced tsunami in diabetic COVID-19 patients.

Keywords: COVID-19; SARS-CoV-2; blood glucose control; coronavirus; diabetes; endothelial dysfunction; metformin.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Blood Glucose / metabolism
  • COVID-19 / complications*
  • COVID-19 / metabolism
  • COVID-19 / virology
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / metabolism
  • Drug Repositioning
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Metformin / administration & dosage*
  • SARS-CoV-2 / drug effects
  • SARS-CoV-2 / genetics
  • SARS-CoV-2 / physiology

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Metformin