• Muhilvannan Somasundaram, Sanjay Kurian Mathew, Soumyajeet Paul, Shilia Jacob Kurian, Vijayanarayana Kunhikatta, Shubhada Karanth, Sahana Shetty, Chandrashekar Udyavara Kudru, Mohan K Manu, Kavitha Saravu, Mazhuvancherry Kesavan Unnikrishnan, Mahadev Rao, and Sonal Sekhar Miraj.
• Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India.
• Ann. Med. 2024 Dec 1; 56 (1): 24258292425829.

BackgroundEvidence shows that diabetes raises the probability of contracting COVID-19 and associated complications. We hypothesize that metformin, being pleiotropic, may improve COVID-19 in diabetics.MethodsA retrospective cohort study was conducted with 421 COVID-19 patients with diabetes, hospitalized between 1st April 2020 and 31st March 2022 in a tertiary-care hospital. Patients with metformin or its combination constituted the study cohort (SC; n = 221), while other antidiabetics constituted the reference cohort (RC; n = 200).ResultsSC and RC were matched for mean age ± SD (SC: 53.3 ± 5.7 vs. RC: 54.3 ± 8.2 years). The mean length of hospitalization (days) was significantly shorter in SC (9.0 ± 5.7) than in RC (12.7 ± 6) (p < 0.02). Metformin use was associated with reduction in mortality risk (OR: 0.106, 95% CI = 0.039-0.287; p < 0.001). Moreover, SC also improved levels of LDH (OR: 0.243, 95% CI = 0.104-0.566; p < 0.001), CRP (OR: 0.281, 95% CI = 0.120-0.659; p < 0.004), and D-dimer (OR: 0.220, 95% CI = 0.089-0.539; p < 0.001) than RC. The calculated number needed to treat for metformin was 3.1.ConclusionMetformin users have a decrease in hospital stay and mortality rates and improvement in LDH, CRP, and D-dimer levels. Therefore, metformin might protect against mortality in COVID-19 with diabetes.

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