Metformin in SARS-CoV-2 infection: A hidden path - from altered inflammation to reduced mortality. A review from the literature

Ana Realista Pedrosa; Diana Cruz Martins; Manfredi Rizzo; José Silva-Nunes

doi:10.1016/j.jdiacomp.2022.108391

Metformin in SARS-CoV-2 infection: A hidden path - from altered inflammation to reduced mortality. A review from the literature

J Diabetes Complications. 2023 Feb;37(2):108391. doi: 10.1016/j.jdiacomp.2022.108391. Epub 2023 Jan 2.

Authors

Ana Realista Pedrosa¹, Diana Cruz Martins², Manfredi Rizzo³, José Silva-Nunes⁴

Affiliations

¹ Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Department of Internal Medicine, Hospital do Espírito Santo de Évora, Évora, Portugal.
² Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.
³ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
⁴ Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; NOVA Medical School/Faculdade de Ciências Medicas, New University of Lisbon, Lisbon, Portugal; Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal. Electronic address: silva.nunes@nms.unl.pt.

Abstract

SARS-CoV-2 infection has been a major threat to human health and a huge challenge to Medicine. In only two years, COVID-19 affected >350 million people, causing >5.6 million deaths. Chronic inflammatory states, such as diabetes or obesity, are known risk factors for COVID-19 poorest outcomes, with higher risk for disease severity and greater mortality. Metformin remains on the first line of the management of hyperglycemia in type 2 diabetes. Through its anti-inflammatory and immunomodulatory mechanisms, metformin appears as an opportunity to control the dysregulated cytokine storm secondary to SARS-CoV-2 infection. Recent studies point towards a potential protective role of metformin in the course of COVID-19, showing that current or previous treatment with metformin associates with better outcomes.

Keywords: COVID-19; Diabetes; Metformin; Mortality; SARS-CoV-2; Severity.

Publication types

Review

MeSH terms

COVID-19* / complications
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / drug therapy
Diabetes Mellitus, Type 2* / epidemiology
Humans
Inflammation / complications
Inflammation / drug therapy
Metformin* / therapeutic use
SARS-CoV-2

Substances

Metformin