Insulin and Metformin Administration: Unravelling the Multifaceted Association with Mortality across Various Clinical Settings Considering Type 2 Diabetes Mellitus and COVID-19
Łukasz Lewandowski,
Agnieszka Bronowicka-Szydełko,
Maciej Rabczyński,
Dorota Bednarska-Chabowska,
Joanna Adamiec-Mroczek,
Adrian Doroszko,
Małgorzata Trocha,
Krzysztof Kujawa,
Agnieszka Matera-Witkiewicz,
Edwin Kuźnik,
Paweł Lubieniecki,
Marcin Madziarski,
Janusz Sokołowski,
Ewa A. Jankowska,
Katarzyna Madziarska
Affiliations
Łukasz Lewandowski
Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Chałubińskiego Street 10, 50-368 Wroclaw, Poland
Agnieszka Bronowicka-Szydełko
Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Chałubińskiego Street 10, 50-368 Wroclaw, Poland
Maciej Rabczyński
Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Dorota Bednarska-Chabowska
Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Joanna Adamiec-Mroczek
Clinical Department of Ophthalmology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Adrian Doroszko
Department of Cardiology, Faculty of Medicine, 4th Military Hospital, Wroclaw University of Science and Technology, Weigla 5 Street, 50-981 Wroclaw, Poland
Małgorzata Trocha
Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Krzysztof Kujawa
Statistical Analysis Centre, Wroclaw Medical University, K. Marcinkowski Street 2–6, 50-368 Wroclaw, Poland
Agnieszka Matera-Witkiewicz
Screening of Biological Activity Assays and Collection of Biological Material Laboratory, Wroclaw Medical University Biobank, Faculty of Pharmacy, Wroclaw Medical University, Borowska Street 221A, 50-556 Wroclaw, Poland
Edwin Kuźnik
Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Paweł Lubieniecki
Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Marcin Madziarski
Clinical Department of Rheumatology and Internal Medicine, University Hospital, Borowska Street 213, 50-556 Wroclaw, Poland
Janusz Sokołowski
Department of Emergency Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Ewa A. Jankowska
Institute of Heart Diseases, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Katarzyna Madziarska
Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
Due to the molecular mechanisms of action of antidiabetic drugs, they are considered to be effective in the treatment of both COVID-19 and the post-COVID-19 syndromes. The aim of this study was to determine the effect of administering insulin and metformin on the mortality of patients with type 2 diabetes (T2DM) with symptomatic COVID-19 with the use of logistic regression models. The association between death and insulin and metformin was weak and could not be included in the multivariate model. However, the interaction of both drugs with other factors, including remdesivir and low-molecular-weight heparin (metformin), age and hsCRP (insulin), modulated the odds of death. These interactions hint at multifaceted (anti-/pro-) associations of both insulin and metformin with the odds of death, depending on the patient’s characteristics. In the multivariate model, RDW-SD, adjusted with low-molecular-weight heparin treatment, age, sex and K+, was associated with mortality among patients with COVID-19 and T2DM. With a 15% increase in RDW-SD, the risk of death increased by 87.7%. This preliminary study provides the foundations for developing further, more personalized models to assess the risk of death in T2DM patients, as well as for identifying patients at an increased risk of death due to COVID-19.
