المؤلفون: Klein, Klara R.¹ (AUTHOR) klara_klein@med.unc.edu, Abrahamsen, Trine J.² (AUTHOR), Kahkoska, Anna R.^1,3 (AUTHOR), Alexander, G. Caleb^4,5,6 (AUTHOR), Chute, Christopher G.⁷ (AUTHOR), Haendel, Melissa⁸ (AUTHOR), Hong, Stephanie S.⁶ (AUTHOR), Mehta, Hemalkumar⁵ (AUTHOR), Moffitt, Richard⁹ (AUTHOR), Stürmer, Til¹⁰ (AUTHOR), Kvist, Kajsa² (AUTHOR), Buse, John B.¹ (AUTHOR)

المصدر: Diabetes Therapy. May2024, Vol. 15 Issue 5, p1169-1186. 18p.

مصطلحات موضوعية: *SARS-CoV-2, *GLUCAGON-like peptide-1 receptor, *EMERGENCY room visits, *CD26 antigen

مستخلص: Introduction: People with type 2 diabetes are at heightened risk for severe outcomes related to COVID-19 infection, including hospitalization, intensive care unit admission, and mortality. This study was designed to examine the impact of premorbid use of glucagon-like peptide-1 receptor agonist (GLP-1RA) monotherapy, sodium-glucose cotransporter-2 inhibitor (SGLT-2i) monotherapy, and concomitant GLP1-RA/SGLT-2i therapy on the severity of outcomes in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods: Utilizing observational data from the National COVID Cohort Collaborative through September 2022, we compared outcomes in 78,806 individuals with a prescription of GLP-1RA and SGLT-2i versus a prescription of dipeptidyl peptidase 4 inhibitors (DPP-4i) within 24 months of a positive SARS-CoV-2 PCR test. We also compared concomitant GLP-1RA/SGLT-2i therapy to GLP-1RA and SGLT-2i monotherapy. The primary outcome was 60-day mortality, measured from the positive test date. Secondary outcomes included emergency room (ER) visits, hospitalization, and mechanical ventilation within 14 days. Using a super learner approach and accounting for baseline characteristics, associations were quantified with odds ratios (OR) estimated with targeted maximum likelihood estimation (TMLE). Results: Use of GLP-1RA (OR 0.64, 95% confidence interval [CI] 0.56–0.72) and SGLT-2i (OR 0.62, 95% CI 0.57–0.68) were associated with lower odds of 60-day mortality compared to DPP-4i use. Additionally, the OR of ER visits and hospitalizations were similarly reduced with GLP1-RA and SGLT-2i use. Concomitant GLP-1RA/SGLT-2i use showed similar odds of 60-day mortality when compared to GLP-1RA or SGLT-2i use alone (OR 0.92, 95% CI 0.81–1.05 and OR 0.88, 95% CI 0.76–1.01, respectively). However, lower OR of all secondary outcomes were associated with concomitant GLP-1RA/SGLT-2i use when compared to SGLT-2i use alone. Conclusion: Among adults who tested positive for SARS-CoV-2, premorbid use of either GLP-1RA or SGLT-2i is associated with lower odds of mortality compared to DPP-4i. Furthermore, concomitant use of GLP-1RA and SGLT-2i is linked to lower odds of other severe COVID-19 outcomes, including ER visits, hospitalizations, and mechanical ventilation, compared to SGLT-2i use alone. Graphical abstract available for this article. [ABSTRACT FROM AUTHOR]

المؤلفون: Kahkoska, Anna R., Abrahamsen, Trine Julie, Alexander, G. Caleb, Bennett, Tellen D., Chute, Christopher G., Haendel, Melissa A., Klein, Klara R., Mehta, Hemalkumar, Miller, Joshua D., Moffitt, Richard A., Stürmer, Til, Kvist, Kajsa, Buse, John B., Duong, Tim Q., N3C Consortium

المصدر: Diabetes Care; Jul2021, Vol. 44 Issue 7, p1564-1572, 9p

مصطلحات موضوعية: SODIUM-glucose cotransporter 2 inhibitors, GLUCAGON-like peptide 1, PEPTIDE receptors, COVID-19, GLUCAGON-like peptide-1 receptor, THROMBOPOIETIN receptors

مستخلص: Objective: To determine the respective associations of premorbid glucagon-like peptide-1 receptor agonist (GLP1-RA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i) use, compared with premorbid dipeptidyl peptidase 4 inhibitor (DPP4i) use, with severity of outcomes in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Research Design and Methods: We analyzed observational data from SARS-CoV-2-positive adults in the National COVID Cohort Collaborative (N3C), a multicenter, longitudinal U.S. cohort (January 2018-February 2021), with a prescription for GLP1-RA, SGLT2i, or DPP4i within 24 months of positive SARS-CoV-2 PCR test. The primary outcome was 60-day mortality, measured from positive SARS-CoV-2 test date. Secondary outcomes were total mortality during the observation period and emergency room visits, hospitalization, and mechanical ventilation within 14 days. Associations were quantified with odds ratios (ORs) estimated with targeted maximum likelihood estimation using a super learner approach, accounting for baseline characteristics.Results: The study included 12,446 individuals (53.4% female, 62.5% White, mean ± SD age 58.6 ± 13.1 years). The 60-day mortality was 3.11% (387 of 12,446), with 2.06% (138 of 6,692) for GLP1-RA use, 2.32% (85 of 3,665) for SGLT2i use, and 5.67% (199 of 3,511) for DPP4i use. Both GLP1-RA and SGLT2i use were associated with lower 60-day mortality compared with DPP4i use (OR 0.54 [95% CI 0.37-0.80] and 0.66 [0.50-0.86], respectively). Use of both medications was also associated with decreased total mortality, emergency room visits, and hospitalizations.Conclusions: Among SARS-CoV-2-positive adults, premorbid GLP1-RA and SGLT2i use, compared with DPP4i use, was associated with lower odds of mortality and other adverse outcomes, although DPP4i users were older and generally sicker. [ABSTRACT FROM AUTHOR]

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