SynthesisThe Annals of pharmacotherapy2023

Effect of Antidiabetic Therapy on Clinical Outcomes of COVID-19 Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Kegang Zhan, Liuqi Weng, Li Qi, Luhan Wang, Hao Lin, Xiaoyu Fang, Hong Jia, Xiangyu Ma

Open access · greenAbstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in The Annals of pharmacotherapy, 2023. The graph read 5 numbers from its abstract, feeding 1 cell of the map, but none could be read as for or against, so it casts no vote. It also reports 5 associations that do not count as treatment evidence, such as OR 1.52 (1.32 to 1.75) for all-cause mortality. Cited by 7 papers, 2 of them syntheses that pooled it.

5numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
0.9field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

All-cause mortalityan association or prognostic statement, not a treatment comparison · head-to-head · t2dfeeds one cell of the map
OR 1.521.32 to 1.75
We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75).
All-cause mortalityan association or prognostic statement, not a treatment comparison · head-to-head · t2dfeeds one cell of the map
OR 0.830.70 to 0.98
We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75).
All-cause mortalityan association or prognostic statement, not a treatment comparison · head-to-head · t2dfeeds one cell of the map
OR 0.800.73 to 0.88
We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75).
All-cause mortalityan association or prognostic statement, not a treatment comparison · head-to-head · t2dfeeds one cell of the map
OR 2.321.34 to 4.01
We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75).
All-cause mortalityan association or prognostic statement, not a treatment comparison · head-to-head · t2dfeeds one cell of the map
OR 0.660.58 to 0.75
We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Metformin×all-cause mortality

No readable resultOpen on the map →What to test next →

1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.25no deciding trial · 0 families support, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT000387272,779 enrolled · 1996
HR 0.990.79 to 1.25

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Review
  6. Association of Premorbid GLP-1RA and SGLT-2i Prescription Alone and in Combination with COVID-19 Severity.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2024
    Article
  7. Review
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Kegang ZhanCollege of Public Health, Southwest Medical University, Luzhou, China.
Liuqi WengDepartment of Orthopedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
Li QiDepartment of Infectious Disease Control and Prevention, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China.
Luhan WangDepartment of Epidemiology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, China.ORCID 0000-0001-7917-9071
Hao LinWest China School of Clinical Medicine, Sichuan University, Chengdu, China.
Xiaoyu FangDepartment of Epidemiology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, China.
Hong JiaCollege of Public Health, Southwest Medical University, Luzhou, China.
Xiangyu MaDepartment of Epidemiology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, China.ORCID 0000-0001-7967-3950
Army Medical University · CNChildren's Hospital of Chongqing Medical University · CNSichuan University · CNSouthwest Medical University · CN

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundNo study has yet systematically evaluated the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with type 2 diabetes (T2D).

objectiveWe aimed to evaluate the effect of different antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D.

methodsWe comprehensively retrieved the published research which examined the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D. The odds ratio (OR) and its 95% confidence interval (95% CI) for clinical outcomes were calculated using the random-effects model, and meta-regression was adopted to evaluate the potential sources of heterogeneity between studies.

resultsA total of 54 studies were included in this study. We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75). No statistically significant associations were identified for DPP-4i, SUs, AGIs, and TZDs. CONCLUSION AND RELEVANCE: We demonstrated that the usage of metformin, SGLT-2i, and GLP-1ra could significantly decrease mortality in COVID-19 patients with T2D. The heterogeneity across the studies, baseline characteristics of the included patients, shortage of dosage and the duration of antidiabetic drugs and autonomy of drug selection might limit the objectivity and accuracy of results. Further adequately powered and high-quality randomized controlled trials are warranted for conclusive findings.

Indexed as

COVID-19Diabetes Mellitus, Type 2Dipeptidyl-Peptidase IV InhibitorsMetforminGlucagon-Like Peptide-1 ReceptorHumansHypoglycemic AgentsDipeptidyl-Peptidase IV InhibitorsGlucagon-Like Peptide-1 ReceptorHypoglycemic AgentsMetforminantidiabetic therapyCOVID-19diabetesmeta-analysisSARS-CoV-2

Identifiers

PMID36314281
PMCPMC9618918
OpenAlexW4307810448

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.