Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England

被引:136
作者
Khunti, Kamlesh [1 ,2 ]
Knighton, Peter [1 ,3 ]
Zaccardi, Francesco [2 ]
Bakhai, Chirag [4 ]
Barron, Emma [4 ]
Holman, Naomi [1 ,3 ,4 ,5 ]
Kar, Partha [1 ,4 ,6 ]
Meace, Claire [1 ,3 ]
Sattar, Naveed [1 ,5 ]
Sharp, Stephen [7 ]
Wareham, Nicholas J. [7 ]
Weaver, Andy [4 ]
Woch, Emilia [1 ,3 ]
Young, Bob [1 ,8 ]
Valabhji, Jonathan [1 ,4 ,9 ,10 ]
机构
[1] NHS England & Improvement, Natl Diabet Audit Programme, London, England
[2] Univ Leicester, Leicester Gen Hosp, Leicester Real World Evidence Unit, Diabet Res Ctr, Leicester, Leics, England
[3] NHS Digital, Leeds, W Yorkshire, England
[4] NHS England & NHS Improvement, London, England
[5] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland
[6] Portsmouth Hosp NHS Portsmouth, Portsmouth, Hants, England
[7] Univ Cambridge, MRC Epidemiol Unit, Inst Metab Sci, Cambridge, England
[8] Diabet UK, London, England
[9] Imperial Coll Healthcare NHS Trust, St Marys Hosp, Dept Endocrinol & Diabet, London, England
[10] Imperial Coll London, Div Metab Digest & Reprod, London, England
基金
英国医学研究理事会;
关键词
PROPENSITY SCORE; METFORMIN; ASSOCIATION; MANAGEMENT; OUTCOMES; INSULIN;
D O I
10.1016/S2213-8587(21)00050-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background In patients with type 2 diabetes, hyperglycaemia is an independent risk factor for COVID-19-related mortality. Associations between pre-infection prescription for glucose-lowering drugs and COVID-19-related mortality in people with type 2 diabetes have been postulated but only investigated in small studies and limited to a few agents. We investigated whether there are associations between prescription of different classes of glucose-lowering drugs and risk of COVID-19-related mortality in people with type 2 diabetes. Methods This was a nationwide observational cohort study done with data from the National Diabetes Audit for people with type 2 diabetes and registered with a general practice in England since 2003. Cox regression was used to estimate the hazard ratio (HR) of COVID-19-related mortality in people prescribed each class of glucose-lowering drug, with covariate adjustment with a propensity score to address confounding by demographic, socioeconomic, and clinical factors. Findings Among the 2 851 465 people with type 2 diabetes included in our analyses, 13 479 (0.5%) COVID-19-related deaths occurred during the study period (Feb 16 to Aug 31, 2020), corresponding to a rate of 8.9 per 1000 person-years (95% CI 8.7-9.0). The adjusted HR associated with recorded versus no recorded prescription was 0.77 (95% CI 0.73-0.81) for metformin and 1.42 (1.35-1.49) for insulin. Adjusted HRs for prescription of other individual classes of glucose-lowering treatment were as follows: 0.75 (0.48-1.17) for meglitinides, 0.82 (0.74-0.91) for SGLT2 inhibitors, 0.94 (0.82-1.07) for thiazolidinediones, 0.94 (0.89-0.99) for sulfonylureas, 0.94 (0.83-1.07) for GLP-1 receptor agonists, 1.07 (1.01-1.13) for DPP-4 inhibitors, and 1.26 (0.76-2.09) for alpha-glucosidase inhibitors. Interpretation Our results provide evidence of associations between prescription of some glucose-lowering drugs and COVID-19-related mortality, although the differences in risk are small and these findings are likely to be due to confounding by indication, in view of the use of different drug classes at different stages of type 2 diabetes disease progression. In the context of the COVID-19 pandemic, there is no clear indication to change prescribing of glucoselowering drugs in people with type 2 diabetes. Copyright (C) 2021 Elsevier Ltd. All rights reserved.
引用
收藏
页码:293 / 303
页数:11
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