Vol 11, No 6 (2022)
Observation letter
Published online: 2022-12-27

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Association between Use of Metformin and Insulin with Hematological Parameters in COVID-19 Patients with Type 2 Diabetes: A Single Center, Cross-Sectional Study

Pavlo Petakh12, Vitaliia Isevych3, Issah Bin Mohammed3, Kateryna Loshak4, Ivan Poliak5, Aleksandr Kamyshnyiy2
Clin Diabetol 2022;11(6):432-433.

Abstract

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OBSERVATION LETTER

ISSN 2450–7458
e-ISSN 2450–8187

Association between Use of Metformin and Insulin with Hematological Parameters in COVID-19 Patients with Type 2 Diabetes: A Single Center, Cross-Sectional Study

Pavlo Petakh12Vitaliia Isevych3Issah Bin Mohammed3Kateryna Loshak4Ivan Poliak5Aleksandr Kamyshnyiy1
1Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
2Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
3Uzhhorod, Ukraine
4Department of Internal Diseases, Uzhhorod National University, Uzhhorod, Ukraine
5Transcarpathian Regional Clinical Infectious Hospital, Uzhhorod, Ukraine

Address for correspondence:

Pavlo Petakh

Department of Biochemistry and Pharamcology

Uzhhorod National University

Narodna Square 1, 88000 Uzhhorod, Ukraine

e-mail: pavlo.petakh@uzhnu.edu.ua

Clin Diabetol 2022, 11; 6: 433–434

DOI: 10.5603/DK.a2022.0055

Received: 11.10.2022 Accepted: 12.10.2022

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first reported in December 2019 [1].

Type 2 diabetes (T2D) is an important risk factor for mortality and poor prognosis in COVID-19 patients [2, 3]. Metformin and insulin were suggested to have an impact on the outcomes. However, opposing viewpoints continue to be expressed. In this study, we sought to perform a retrospective analysis of metformin and insulin effects in COVID-19 patients with T2D.

This was a retrospective study conducted at the Transcarpathian Regional Clinical Infectious Diseases Hospital (Uzhhorod, Ukraine). We used retrospective patient data collected from medical records available from the e-health information system, which included all adult patients admitted from January 2021 to March 2022. Confirmation of the diagnosis of COVID-19 was carried out by the PCR method. In-hospital confirmed COVID-19 patients were divided into T2D and non-diabetes. T2D was defined according to the World Health Organization diagnostic criteria [4].

The results are reported as the median [interquartile range (IQR)] for baseline laboratory indices and the number [percentage] for categorical variables. The classification variable was represented as a count (%). Continuous variables with normal distribution were presented as mean [standard deviation (SD)]. Differences in parameters among groups were analyzed using ANOVA for continuous variables, and the χ2 test was used for categorical variables. P-value ≤ 0.05 was considered to indicate statistical significance.

Among the 145 confirmed patients, the median age was 62.66 ± 12.96, and 66 patients (45.5%) were male. Patients with T2DM were older than patients without T2D 53.66 ± 13.37 vs. 67.00 ± 7.70 (p = < 0.001). Among these 80 diabetic patients, all had T2D.

During hospitalization, 25 cases with T2D had metformin. Patients had in-hospital metformin with a median of 1.0 g per day (IQR 0.551.52). In patients who took metformin, the level of C-reactive protein (CRP) was significantly lower than in patients who did not take metformin [24 mg/L (IQR 1558) vs. 52 mg/L, (IQR 22121), p = 0.046] (Tab. 1).

Table 1. Characteristics of Baseline Laboratory Indices in Metformin or Insulin Users

Characteristics

Non-metformin
(N = 16)

Metformin
(N = 25)

P-value

Non-insulin
(N = 10)

Insulin
(N = 35)

P-value

Age [years]

58.67 ± 10.81

60.80 ± 12.56

0.518

52.67 ± 8.81

67.8 ± 9.26

0.038

Gender (M, %)

7 (43.7 %)

12 (48 %)

0.657

6 (60 %)

17 (48.5 %)

Comorbidities (n, %)

Hypertension, N (%)

7 (43.7%)

7 (28%)

0.257

3 (30%)

9 (25.7%)

0.436

Cardiovascular disease, N (%)

2 (12.5%)

4 (16%)

0.368

1 (10%)

5 (14.2%)

0.813

Chronic kidney disease, N (%)

7 (43.7%)

7 (28%)

0.537

4 (40%)

10 (28.5%)

0.251

Baseline laboratory indices

Blood glucose [mmol/L]

7 (5–14)

10 (8–14)

0.014

5 (4–8)

14 (9–15)

< 0.001

White blood cells [× 109/L]

8 (6–12)

9 (6–10)

0.463

7 (5–11)

9 (7–12)

0.082

Lymphocytes [× 109/L]

1 (1–1)

1 (1–1)

0.666

1 (1–2)

1 (1–1)

0.430

Monocytes [× 109/L]

0 (0–0)

0 (0–0)

0.040

0 (0–0)

0 (0–0)

0.368

Neutrophils [× 109/L]

7 (5–11)

7 (4–9)

0.315

6 (4–8)

9 (6–11)

0.022

Serum creatinine [μmol/L]

102 (86–119)

105 (90–124)

0.644

102 (86–118)

102 (87–127)

0.647

C-reactive protein [mg/L]

52 (22–121)

24 (15–58)

0.046

40 (16–104)

43 (18–100)

0.846

D-dimer [μg/mL]

1 (0–3)

1 (0–3)

0.544

1 (0–3)

2 (1–3)

0.181

Procalcitonin [ng/mL]

0 (0–1)

0 (0–1)

0.660

0 (0–1)

0 (0–1)

0.340

COVID-19 treatment protocols

Antibiotics (n, %)

13 (81.2%)

14 (56%)

0.486

8 (80%)

25 (71.4%)

0.587

After admission, 35 patients received insulin. In-hospital insulin users with a median of 35.0 units per day (IQR 28.250.3). Higher blood glucose levels [14 mmol/L, (IQR 915) vs. 5 mmol/L (IQR 48), p = < 0.001] were seen in insulin users. Patients in the insulin group had higher white blood cell (WBC) count [9 × 109/L, (IQR 712) vs. 7 × 109/L (IQR 511), p = 0.082] and neutrophil levels than those of the non-insulin group [9 × 109/L, (IQR 6 –11) vs. 6 × 109/L (IQR 48), p = 0.022] with no difference in general characteristics and other laboratory indices.

In this study, we found that metformin use prior to admission was linked to declining CRP levels among COVID-19 patients with T2D. In the long run, metformin may be more advantageous than insulin for COVID-19 patients with T2D. To confirm the current findings, more research is required.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

None declared.

References

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