Safety of Metformin in Hospitalized Patients with COVID-19

Mikhail N^1*, Wali S^1
1Endocrinology Division, Department of Medicine, Olive-View-UCLA Medical Center, David-Geffen School of Medicine, CA, USA

Corresponding Author: Nasser Mikhail, MD ^{ORCID ID}
Address: Endocrinology Division, Department of Medicine, Olive-View-UCLA Medical Center, David-Geffen School of Medicine, CA, USA.
Received date: 10 September 2020; Accepted date: 03 October 2020; Published date: 10 October 2020

Citation: Mikhail N, Wali S. Safety of Metformin in Hospitalized Patients with COVID-19. Diab Res Open Access. 2020 Oct 10;2(3):68-71.

Copyright © 2020 Mikhail N, Wali S. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: COVID-19, Diabetes, Metformin, Safety, Mortality, Lactic Acidosis

Abstract

Background: It is unclear whether metformin should be continued or discontinued in patients with coronavirus disease 2019 (COVID-19) admitted to the hospital.
Objective: To review metformin safety, particularly its impact on mortality among hospitalized patients with COVID-19.
Methods: Review of English literature by PUBMED search until September 11, 2020. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed.
Results: Retrospective studies suggest that metformin use prior to hospital admission may be associated with decreased mortality in patients with diabetes admitted to the hospital with COVID-19. Continuing metformin use after hospital admission did not have a significant impact on 28-day all-cause mortality. Metformin use after hospitalization of patients with COVID-19 was associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking 2 gm/d of metformin or higher, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m². Metformin use in the hospital was associated with a significant decrease in the risk of heart failure and acute respiratory distress syndrome (ARDS).
Conclusions: In patients with diabetes and COVID-19 admitted to the hospital, metformin should not be used in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73 m²), and with daily doses of 2 gm or more due to increased risk of lactic acidosis.