Glucose-lowering Drugs and Risk of COVID-19 Mortality in People with T2D

Sarfaroj Khan 


April 02, 2021


  • Type 2 diabetes (T2D) patients prescribed metformin, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sulfonylureas were at a lower risk of COVID-19-related mortality than those not prescribed these drugs.

  • The risk was higher in those prescribed insulin and dipeptidyl peptidase-4 inhibitors (DPP-4i).

  • The differences in risk were small and were likely to be because of confounding rather than direct drug effects.

Why this matters

  • Findings suggest that there is no evidence to change prescribing of glucose-lowering drugs in people with T2D in the context of COVID-19 pandemic.

Study details

  •  A nationwide observational cohort study of 2,851,465 people diagnosed with diabetes who were included in the 2018-2019 National Diabetes Audit dataset and registered with a general practice in England since 2003.

  • Funding: None.

Key results

  • During 1,517,762 person-years of follow-up, 13,479 (0.5%) COVID-19 deaths occurred, corresponding to a crude mortality rate of 8.9 per 1000 person years (95% CI, 8.7-9.0).

  • Adjusted HRs (95% CI) for COVID-19 mortality in patients with prescription of glucose-lowering drug vs no prescription of the drug were:

    • metformin: 0.77 (0.73-0.81);

    • meglinitides: 0.75 (0.48-1.17);

    • SGLT2i: 0.82 (0.74-0.91);

    • thiazolidinediones: 0.94 (0.82-1.07);

    • sulfonylureas: 0.94 (0.89-0.99);

    • GLP-1RA: 0.94 (0.83-1.07);

    • DPP-4i: 1.07 (1.01-1.13);

    • α-glucosidase inhibitors: 1.26 (0.76-2.09); and

    • insulin: 1.42 (1.35-1.49).


  • Data on medication adherence and treatment dose were lacking.

  • Risk of residual confounding.


Khunti K, Knighton P, Zaccardi F, Bakhai C, Barron E, Holman N, Kar P, Meace C, Sattar N, Sharp S, Wareham NJ, Weaver A, Woch E, Young B, Valabhji J. Prescription of glucose-lowering therapies and risk of COVID-19 mortality in people with type 2 diabetes: a nationwide observational study in England. Lancet Diabetes Endocrinol. 2021 Mar 30 [Epub ahead of print]. doi: 10.1016/S2213-8587(21)00050-4.  View full text 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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