Glucose-Lowering Drugs and Outcomes in COVID-19 Patients with Diabetes

Aims: To evaluate the mortality of eight antihyperglycemics for COVID-19 patients with diabetes prior to diagnosis of COVID-19.Materials and Methods: We searched PubMed, Embase, Cochrane Central Register, Web of Science, and ClinicalTrials. gov through 21 March 2022. COVID-19 patients with diabetes while receiving glucose-lowering therapies for at least 14 days prior to COVID-19 confirmed were included. The Newcastle Ottawa scale was used to assess the risk of bias in nonrandomized studies. Bayesian network meta-analyses were performed.Results: Twenty nine distinct observational studies (3,665,644 COVID-19 patients with diabetes mellitus) were included. Compared with insulin, DPP4i, secretagogues, and glucosidase inhibitors, the incidence of adverse outcomes in patients with diabetes who took SGLT2i was relatively lower: OR 2.7 (95% CrI 1.9-3.9); 2,0 (1.4-2.8); 1.6 (1.1-2.4); 1.8 (1.1-3.0); 0.32 (0.16-0.70); 0.47 (0.23-0.95). The SUCRA value of SGLT2i was the lowest (7%), followed by GLPIRA (13%) and biguanides (35%).Conclusion: The limitation of this study is that the differences in basic characteristics among therapies arms were not analyzed. SGLT2I may be an optimal choice for patients with diabetes before COVID-19 infection. GLP1RA and guanidine can also be a good choice for the protection of patients with diabetes during COVID-19 pandemic times.Funding: None to declare. Declaration of Interest: None to declare.