Association of anti-diabetic drugs and COVID-19 outcomes in patients with diabetes mellitus type 2 and cardiomyopathy

Jelena Dimnjaković; Tamara Buble; Pero Ivanko; Ivan Pristaš; Ognjen Brborović; Hana Brborović

doi:10.1038/s41598-024-57871-9

Association of anti-diabetic drugs and COVID-19 outcomes in patients with diabetes mellitus type 2 and cardiomyopathy

Sci Rep. 2024 Mar 27;14(1):7227. doi: 10.1038/s41598-024-57871-9.

Authors

Jelena Dimnjaković¹, Tamara Buble¹, Pero Ivanko¹, Ivan Pristaš¹, Ognjen Brborović², Hana Brborović³

Affiliations

¹ Division for Health Informatics and Biostatistics, Croatian Institute of Public Health, Rockefeller's Street 7, 10 000, Zagreb, Croatia.
² School of Medicine, Andrija Štampar School of Public Health, Department of Social Medicine and Health Care Organization, University of Zagreb, Rockefeller's Street 4, 10 000, Zagreb, Croatia. ognjen.brborovic@mef.hr.
³ School of Medicine, Andrija Štampar School of Public Health, Department of Environmental and Occupational Health and Sports Medicine, University of Zagreb, Rockefeller's Street 4, 10 000, Zagreb, Croatia.

Abstract

There is a scarcity of information on the population with diabetes mellitus type 2 and cardiomyopathy (PDMC) in COVID-19, especially on the association between anti-diabetic medications and COVID-19 outcomes. Study is designed as a retrospective cohort analysis covering 2020 and 2021. Data from National Diabetes Registry (CroDiab) were linked to hospital data, primary healthcare data, the SARS-CoV-2 vaccination database, and the SARS-CoV-2 test results database. Study outcomes were cumulative incidence of SARS-CoV-2 positivity, COVID-19 hospitalizations, and COVID-19 deaths. For outcome predictors, logistic regression models were developed. Of 231 796 patients with diabetes mellitus type 2 in the database, 14 485 patients had cardiomyopathy. The two2-year cumulative incidence of all three studies' COVID-19 outcomes was higher in PDMC than in the general diabetes population (positivity 15.3% vs. 14.6%, p = 0.01; hospitalization 7.8% vs. 4.4%, p < 0.001; death 2.6% vs. 1.2%, p < 0.001). Sodium-Glucose Transporter 2 (SGLT-2) inhibitors therapy was found to be protective of SARS-CoV-2 infections [OR 0.722 (95% CI 0.610-0.856)] and COVID-19 hospitalizations [OR 0.555 (95% CI 0.418-0.737)], sulfonylureas to be risk factors for hospitalization [OR 1.184 (95% CI 1.029-1.362)] and insulin to be a risk factor for hospitalization [OR 1.261 (95% CI 1.046-1.520)] and death [OR 1.431 (95% CI 1.080-1.897)]. PDMC are at greater risk of acquiring SARS-CoV-2 infection and having worse outcomes than the general diabetic population. SGLT-2 inhibitors therapy was a protective factor against SARS-CoV-2 infection and against COVID-19 hospitalization, sulfonylurea was the COVID-19 hospitalization risk factor, while insulin was a risk factor for all outcomes. Further research is needed in this diabetes sub-population.

Keywords: Acarbose; COVID-19; Diabetes mellitus type 2; Dipeptidyl-peptidase 4 inhibitors; Hypoglycemic agents; Insulin; Metformin; Pioglitazone; Repaglinide; Sodium-glucose transporter 2 inhibitors; Sulfonylurea compounds.

MeSH terms

COVID-19 Vaccines / therapeutic use
COVID-19* / complications
Cardiomyopathies* / chemically induced
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / drug therapy
Diabetes Mellitus, Type 2* / epidemiology
Dipeptidyl-Peptidase IV Inhibitors* / therapeutic use
Humans
Hypoglycemic Agents / therapeutic use
Insulin / therapeutic use
Retrospective Studies
SARS-CoV-2
Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
Sulfonylurea Compounds / therapeutic use

Substances

Hypoglycemic Agents
COVID-19 Vaccines
Dipeptidyl-Peptidase IV Inhibitors
Sulfonylurea Compounds
Sodium-Glucose Transporter 2 Inhibitors
Insulin