(Press-News.org) BIRMINGHAM, Ala. - Use of the diabetes drug metformin -- before a diagnosis of COVID-19 -- is associated with a threefold decrease in mortality in COVID-19 patients with Type 2 diabetes, according to a racially diverse study at the University of Alabama at Birmingham. Diabetes is a significant comorbidity for COVID-19.
"This beneficial effect remained, even after correcting for age, sex, race, obesity, and hypertension or chronic kidney disease and heart failure," said Anath Shalev, M.D., director of UAB's Comprehensive Diabetes Center and leader of the study.
"Since similar results have now been obtained in different populations from around the world -- including China, France and a UnitedHealthcare analysis -- this suggests that the observed reduction in mortality risk associated with metformin use in subjects with Type 2 diabetes and COVID-19 might be generalizable," Shalev said.
How metformin improves prognosis in the context of COVID-19 is not known, Shalev says. The UAB findings suggest that the mechanisms may go beyond any expected improvement in glycemic control or obesity, since neither body mass index, blood glucose nor hemoglobin A1C were lower in the metformin users who survived as compared to those who died.
"The mechanisms may involve metformin's previously described anti-inflammatory and anti-thrombotic effects," Shalev said.
The study -- first made available in MedRxiv and now published in the peer-reviewed journal Frontiers in Endocrinology -- included 25,326 patients tested for COVID-19 at the tertiary care UAB Hospital between Feb. 25 and June 22 of last year. Of the 604 patients found to be COVID-19-positive, 311 were African Americans.
The primary outcome in the study was mortality in COVID-19-positive subjects, and the potential association with subject characteristics or comorbidities was analyzed.
Researchers found that Blacks, who are only 26 percent of Alabama's population, were 52 percent of those who tested positive for COVID-19, and only 30 percent of those who tested negative. In contrast, only 36 percent of the COVID-19-positive subjects were white, while whites made up 56 percent of those who tested negative, further underlining the racial disparity. Once COVID-19-positive though, no significant racial difference in mortality was observed.
"In our cohort," Shalev said, "being African American appeared to be primarily a risk factor for contracting COVID-19, rather than for mortality. This suggests that any racial disparity observed is likely due to exposure risk and external socioeconomic factors, including access to proper health care."
Overall mortality for COVID-19-positive patients was 11 percent. The study found that 93 percent of deaths occurred in subjects over the age of 50, and being male or having high blood pressure was associated with a significantly elevated risk of death. Diabetes was associated with a dramatic increase in mortality, with an odds ratio of 3.62. Overall, 67 percent of deaths in the study occurred in subjects with diabetes.
The researchers looked at the effects of diabetes treatment on adverse COVID-19 outcomes, focusing on insulin and metformin as the two most common medications for Type 2 diabetes. They found that prior insulin use did not affect mortality risk.
However, prior metformin use was a different matter. Metformin use significantly reduced the odds of dying, and the 11 percent mortality for metformin users was not only comparable to that of the general COVID-19-positive population, it was dramatically lower than the 23 percent mortality for diabetes patients not on metformin.
After controlling for other covariates, age, sex and metformin use emerged as independent factors affecting COVID-19-related mortality. Interestingly, even after controlling for all these other covariates, death was significantly less likely -- with an odds ratio of 0.33 -- for Type 2 diabetes subjects taking metformin, compared with those who did not take metformin.
"These results suggest that, while diabetes is an independent risk factor for COVID-19-related mortality," Shalev said, "this risk is dramatically reduced in subjects taking metformin -- raising the possibility that metformin may provide a protective approach in this high-risk population."
The researchers say future studies will need to explore how metformin is protective, as well as assess the risks and benefits of metformin treatment and the indications for its use in the face of the ongoing COVID-19 pandemic.
INFORMATION:
This study is part of a new Precision Diabetes Program, a collaboration between the UAB Comprehensive Diabetes Center and the Hugh Kaul Precision Medicine Institute at UAB.
Co-authors with Shalev for the paper, "Metformin use is associated with reduced mortality in a diverse population with COVID-19 and diabetes," are Andrew B. Crouse and Matthew Might, the Hugh Kaul Precision Medicine Institute at UAB; Tiffany Grimes and Fernando Ovalle, the Comprehensive Diabetes Center and the Department of Medicine Division of Endocrinology, Diabetes and Metabolism at UAB; and Peng Li, UAB School of Nursing.
Support came from National Institutes of Health grants DK078752, DK120379 and TR001417.
Shalev is a professor in the UAB Department of Medicine Division of Endocrinology, Diabetes and Metabolism, and she holds the Nancy R. and Eugene C. Gwaltney Family Endowed Chair in Juvenile Diabetes Research.
Ignoring a colleague's greeting or making a sarcastic comment in the workplace may actually do more harm than intended, according to West Virginia University research.
Perceived low-grade forms of workplace mistreatment, such as avoiding eye contact or excluding a coworker from conversation, can amplify suicidal thoughts in employees with mood disorders, based on a study by Kayla Follmer, assistant professor of management, and Jake Follmer, assistant professor of educational psychology.
"We know from prior research that minor forms of workplace mistreatment reduce employee engagement," Kayla Follmer said. "But our paper provided an explanation for ...
New York, NY (January 14, 2020) -- Girls who are emotionally neglected or severely sexually abused early in their lives report riskier sexual behaviors during adolescence, Mount Sinai researchers report. The findings highlight the need--and suggest the potential for tailored approaches--to promote healthy sexual development in vulnerable populations.
The researchers identified four distinct patterns of neglect and sexual abuse in low-income, predominantly Black and/or Latina girls and young women that led to distinct trajectories of risky sexual behavior during adolescence. Their findings were published in Child Development in January.
The study was the first of its kind to identify categories of maltreatment among adolescent girls of color in an urban setting that correspond with measurable ...
The COVID-19 pandemic, which claimed more than 336,000 lives in the United States in 2020, has significantly affected life expectancy, USC and Princeton researchers have found.
The researchers project that, due to the pandemic deaths last year, life expectancy at birth for Americans will shorten by 1.13 years to 77.48 years, according to their study published Thursday in the Proceedings of the National Academy of Sciences.
That is the largest single-year decline in life expectancy in at least 40 years and is the lowest life expectancy estimated since ...
A team of biophysicists from the University of Massachusetts Amherst and Penn State College of Medicine set out to tackle the long-standing question about the nature of force generation by myosin, the molecular motor responsible for muscle contraction and many other cellular processes. The key question they addressed - one of the most controversial topics in the field - was: how does myosin convert chemical energy, in the form of ATP, into mechanical work?
The answer revealed new details into how myosin, the engine of muscle and related motor proteins, transduces energy.
In the end, their unprecedented research, meticulously ...
Humans, mammals and birds that live in a particular environment share a common set of behavioral traits, according to a new study, which identifies a local convergence of foraging, reproductive and social behaviors across species. The findings, based on studying more than 300 small-scale human hunter-gatherer populations, support one of the central tenets of human behavioral ecology - that ecological forces select for various behaviors in distinct environments, driving behavioral diversity worldwide. The origin and evolution of human behavior are uncertain and debated. While some suggest ...
The volatile plant hormone ethylene allows plant roots to sense and avoid compacted soils, researchers report. Rendering roots insensitive to ethylene allowed them to penetrate compacted soils more effectively, the same group showed. The findings reveal how plants regulate their growth in response to soil compaction - a growing challenge facing modern agriculture worldwide - and could serve as a pathway for how breeders might select or develop new crops resilient to soil compaction. Driven in part by a growing reliance on heavy machinery and poor soil management practices, soil compaction can lead to declining crop yields by restricting root growth and limiting the availability ...
A large class of mammalian genes is not completely shared throughout sperm development and differentiation, according to a new study of sperm in organisms including mice, macaques and men. The findings provide an explanation to why testis gene expression patterns often appear as an outlier relative to all other tissues. In mammals, spermatogenesis includes a long stage of haploid gene expression, which could lead to variation between individual sperm cells, resulting in sperm-level natural selection and trait inheritance. However, during differentiation, maturing haploid spermatids ...
Foraging humans find food, reproduce, share parenting, and even organise their social groups in similar ways as surrounding mammal and bird species, depending on where they live in the world, new research has found.
The study, published today in Science, shows environmental factors exert a key influence on how foraging human populations and non-human species behave, despite their very different backgrounds.
The team of international researchers analysed data from more than 300 locations around the world, observing the behaviours of foraging human populations ...
Scientists have discovered a signal that causes roots to stop growing in hard soils which can be 'switched off' to allow them to punch through compacted soil - a discovery that could help plants to grow in even the most damaged soils.
An international research team, led by scientists from the University of Nottingham's Future Food Beacon and Shanghai Jiao Tong University has discovered how the plant signal 'ethylene' causes roots to stop growing in hard soils, but after this signal is disabled, roots are able to push through compacted soil. The research has been published in Science.
Hard (compacted) soils represent a major challenge facing modern agriculture that can reduce crop yields over 50% by reducing root growth, causing significant losses annually. Europe has over 33-million-hectares ...
CAMBRIDGE, MA -- One reason it's so difficult to produce effective vaccines against some viruses, including influenza and HIV, is that these viruses mutate very rapidly. This allows them to evade the antibodies generated by a particular vaccine, through a process known as "viral escape."
MIT researchers have now devised a new way to computationally model viral escape, based on models that were originally developed to analyze language. The model can predict which sections of viral surface proteins are more likely to mutate in a way that enables viral escape, and it can also identify sections that are less likely to mutate, making them good targets ...
