Covid-19, the growing pandemic with a rising death toll has been associated with many comorbidities as well as racial disparity. However, specific characteristics of these at-risk populations remain obscure. Moreover, there is a lack of approaches to lower mortality related to Covid-19. Thus, a retrospective electronic health record data analysis of 25,326 individuals tested for Covid-19 between 25 February and 22 June 2020 at a tertiary health care center in the Southern U.S was performed to determine mortality in COVID-19-positive patients. In addition, the link with individual characteristics and comorbidities was assessed. It was seen that the odds ratio of contracting Covid-19 was disproportionately high in Blacks/African-Americans [Odds ratio (OR) 2.6; 95% confidence interval (CI) 2.19-3.10; p<0.0001)] and in people with obesity (OR 1.93; 95%CI 1.64-2.28; p<0.0001), hypertension (OR 2.46; 95%CI 2.07-2.93; p<0.0001), and diabetes (OR 2.11; 95%CI 1.78-2.48; p<0.0001). A dramatic increase in mortality (OR 3.62; 95%CI 2.11-6.2; p<0.0001) was reported in patients with diabetes. Diabetes emerged as an independent risk factor in this diverse population even after correcting for age, race, gender, obesity and hypertension. It is noteworthy that treatment with metformin was independently associated with marked reduction in mortality in patients with diabetes and Covid-19 (OR 0.33; 95%CI 0.13-0.84; p=0.0210). These findings suggest that although diabetes is an independent risk factor for Covid-19-related mortality, this risk can be reduced significantly in people taking metformin, thereby raising the possibility that metformin therapy may be a protective approach in this high-risk population. The researchers have suggested that metformin is likely to reduce the mortality rate by decreasing the inflammatory response, and the incidence of cytokine storm or vascular damage. On the basis of this data, physicians can consider adding metformin into the treatment regimen of their diabetes patients, if they are not receiving this drug yet. Others should be advised to continue taking metformin during the Covid-19 pandemic due to its potential benefit in reducing the mortality rate.

References

1. Crouse A, Grimes T, Li P, et al. Metformin use is associated with reduced mortality in a diverse population with Covid-19 and diabetes. medRxiv. 2020 Jul 31;2020.07.29.20164020.
2. Hariyanto TI, Kurniawan A. Metformin use is associated with reduced mortality rate from coronavirus disease 2019 (COVID-19) infection. Obes Med. 2020;19:100290.