Diabetes medications and associations with Covid-19 outcomes in the N3C database: A national retrospective cohort study.
Diabetes medications and associations with Covid-19 outcomes in the N3C database: A national retrospective cohort study.
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N3C数据库中的糖尿病药物和与COVID-19结果的关联：国家回顾性队列研究。
DOI：
10.1371/journal.pone.0271574
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Buse, John B.
中科院分区：
文献类型：
--
作者：
Bramante, Carolyn T.;Johnson, Steven G.;Garcia, Victor;Evans, Michael D.;Harper, Jeremy;Wilkins, Kenneth J.;Huling, Jared D.;Mehta, Hemalkumar;Alexander, Caleb;Tronieri, Jena;Hong, Stephenie;Kahkoska, Anna;Alamgir, Joy;Koraishy, Farrukh;Hartman, Katrina;Yang, Kaifeng;Abrahamsen, Trine;Sturmer, Til;Buse, John B.
虽然疫苗接种是对抗SARS-CoV-2大流行的最重要方法，但可能仍然需要早期门诊治疗，这种治疗安全、廉价，目前在世界上无法获得疫苗的部分地区广泛可用。有计算机、体外和组织内数据表明，二甲双胍抑制病毒生命周期，以及观察数据表明，在感染SARS-CoV2之前使用二甲双胍与较轻的COVID-19有关。以往单中心队列的观察性分析受到规模的限制。对2型糖尿病（T2DM）成人患者进行回顾性队列分析，研究二甲双胍使用与COVID-19结局之间的关系，并对治疗等效糖尿病单一疗法的流行使用者进行积极比较设计：二甲双胍与二肽基肽酶-4抑制剂（DPP4i）和磺脲类药物（SU）。这是在2020年1月1日至2021年6月1日期间美国国家COVID队列协作（N3C）纵向SARS-CoV-2阳性成人队列中进行的。调查结果包括COVID-19的住院或通气或死亡率。背部疼痛被评估为阴性对照结果。来自36个地点的6626名T2DM和+SARS-CoV-2成人。平均年龄60.7±12.0岁；男性48.7%;白人占56.7%，黑人占21.9%，亚裔占3.5%，拉丁裔占16.7%。平均BMI为34.1±7.8kg/m2。总体而言，14.5%的样本住院；1.5%接受机械通气；1.8%的人死亡。在调整后的结果中，与DPP4i相比，二甲双胍与减少通气需求（RR 0.68, 0.32-1.44）和死亡率（RR 0.82, 0.41-1.64）无显著相关性。与SU相比，二甲双胍与较低的通气风险（RR 0.5, 95%CI 0.28-0.98, p = 0.044）和死亡率（RR 0.56, 95%CI 0.33-0.97, p = 0.037）相关。阴性对照的未校正和校正结果无差异。与SU相比，使用二甲双胍与较轻的COVID-19之间存在临床显著相关性，但与DPP4i相比没有显著相关性。需要进行新用户研究和随机试验，以评估早期门诊治疗和暴露后预防，使用对成人、儿童、孕妇安全且全球可用的治疗方法。
While vaccination is the most important way to combat the SARS-CoV-2 pandemic, there may still be a need for early outpatient treatment that is safe, inexpensive, and currently widely available in parts of the world that do not have access to the vaccine. There are in-silico, in-vitro, and in-tissue data suggesting that metformin inhibits the viral life cycle, as well as observational data suggesting that metformin use before infection with SARS-CoV2 is associated with less severe COVID-19. Previous observational analyses from single-center cohorts have been limited by size. Conducted a retrospective cohort analysis in adults with type 2 diabetes (T2DM) for associations between metformin use and COVID-19 outcomes with an active comparator design of prevalent users of therapeutically equivalent diabetes monotherapy: metformin versus dipeptidyl-peptidase-4-inhibitors (DPP4i) and sulfonylureas (SU). This took place in the National COVID Cohort Collaborative (N3C) longitudinal U.S. cohort of adults with +SARS-CoV-2 result between January 1 2020 to June 1 2021. Findings included hospitalization or ventilation or mortality from COVID-19. Back pain was assessed as a negative control outcome. 6,626 adults with T2DM and +SARS-CoV-2 from 36 sites. Mean age was 60.7 +/- 12.0 years; 48.7% male; 56.7% White, 21.9% Black, 3.5% Asian, and 16.7% Latinx. Mean BMI was 34.1 +/- 7.8kg/m2. Overall 14.5% of the sample was hospitalized; 1.5% received mechanical ventilation; and 1.8% died. In adjusted outcomes, compared to DPP4i, metformin had non-significant associations with reduced need for ventilation (RR 0.68, 0.32–1.44), and mortality (RR 0.82, 0.41–1.64). Compared to SU, metformin was associated with a lower risk of ventilation (RR 0.5, 95% CI 0.28–0.98, p = 0.044) and mortality (RR 0.56, 95%CI 0.33–0.97, p = 0.037). There was no difference in unadjusted or adjusted results of the negative control. There were clinically significant associations between metformin use and less severe COVID-19 compared to SU, but not compared to DPP4i. New-user studies and randomized trials are needed to assess early outpatient treatment and post-exposure prophylaxis with therapeutics that are safe in adults, children, pregnancy and available worldwide.
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影响因子：
5.4
作者：
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通讯作者：
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影响因子：
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DOI：
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发表时间：
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DOI：
10.1093/jamia/ocaa196
发表时间：
2021-03-01
影响因子：
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作者：
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通讯作者：
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