A type of drug already used to treat obesity and Type 2 diabetes is associated with a reduced risk of hospitalisation, respiratory complications and death in COVID-19 patients with Type 2 diabetes, when taken six months prior to diagnosis with the viral disease, according to a study. Researchers at Penn State College of Medicine in the US analysed electronic medical records of nearly 30,000 patients with type 2 diabetes who had a positive laboratory test for SARS-CoV-2 between January and September 2020.
The study, published in the journal Diabetes on Tuesday, concluded that the drugs, called glucagon-like peptide-1 receptor (GLP-1R) agonists, should be further evaluated for potential protective effects against COVID-19 complications. "Our results are very promising as GLP-1R agonist treatment appears to be highly protective, but more research is needed to establish a causal relationship between the use of these drugs and decreased risk for severe COVID-19 outcomes in patients with Type 2 diabetes," said Patricia Grigson, a professor at Penn State.
According to the researchers, even though vaccines remain the most effective protection against hospitalisation and death from COVID-19, additional effective therapies are needed to improve outcomes for patients with rare, severe breakthrough infections. Patients living with pre-existing conditions like diabetes are at increased risk of severe COVID-19 complications, including death. A recent study from the UK reported that close to a third of COVID-19-related deaths in the country were among patients living with Type 2 diabetes.
Nyland, study co-authors Jennifer Nyland, assistant professor at Penn State, and Nazia Raja Khan, associate professor at Penn State, were studying how GLP-1R agonists could be used to treat substance use disorders. They hypothesised that patients with Type 2 diabetes who are taking these same medications might have some level of protection from severe COVID-19 outcomes based on their anti-inflammatory properties.
Patients with Type 2 diabetes often struggle with dysregulated inflammation, or swelling of body tissues. Overactive inflammatory responses have been implicated in severe COVID-19 cases and deaths. The data for the study came from TriNetX, a web-based tool that allows researchers to use de-identified patient data from multiple health care organisations for research studies.
More than 23,000 patients with Type 2 diabetes and a COVID-19 diagnosis who were not taking the drugs of interest were used as the control group for comparison. The researchers found that patients with Type 2 diabetes who were taking GLP-1R agonists within six months prior to their COVID-19 diagnosis were significantly less likely to be hospitalised, have respiratory complications and die from the disease for 28 days following their diagnosis when compared to patients similar in age, sex, race, ethnicity, body mass index and pre-existing conditions.
The researchers also studied two other drugs that are used as treatments for Type 2 diabetes and are known to have anti-inflammatory effects — dipeptidyl peptidase-4 (DPP-4) inhibitors and pioglitazone. While the use of DPP-4 inhibitors showed a reduced risk of respiratory complications and pioglitazone showed a decreased risk of hospital admission, neither drug showed a decreased risk of death or as strong of trends as GLP-1R agonists in reducing COVID-19 complications across the board, they said.
The researchers said randomised clinical trials are needed to determine if the association between use of GLP-1R agonists and reduced risk for severe COVID-19 outcomes suggested in the study are due to a cause-and-effect relationship. They said there are also questions about the timing of administration of GLP-1R agonists in relation to its supposed protective effects and whether the protective effects could be applied to patients without Type 2 diabetes. "Further research is needed to confirm whether GLP-1R agonists can protect against severe COVID-19 complications," said Raja-Khan. "There is also a need to determine the conditions in which these drugs could be protective and how they could be used safely during COVID-19 hospitalisation," she added.