Is Metformin Use Associated With a Decreased Mortality for COVID-19 Diabetic Patients? A Meta-Analysis
Bibliographic record
Abstract
Abstract Introduction: Coronavirus disease 2019 (COVID-19) has been spreading globally for more than half a year. Previous studies remain controversial regarding whether metformin is associated with reduced risk for COVID-19 diabetic patients. Thus, this meta-analysis is performed. Method: A comprehensive literature search on PubMed and Web of Science was conducted to identify all relevant studies published prior to October 2020 according to the established inclusion criteria. This meta-analysis was reported in conformity to the Preferred Reporting Project declared by the Systematic Review and Meta-Analysis (PRISMA). The quality assessment was performed by the Newcastle-Ottawa Scale (NOS). The pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated to estimate the association between metformin use and mortality for COVID-19 patients. A random-effect or fixed-effect model was used based on heterogeneity significance. Subgroup analysis was performed based on in-hospital-use or home-use, and different sample sizes. Sensitivity analysis and publication bias detection were also performed. All statistical analyses were performed using RevMan software (version 5.3; Cochrane library) and STATA 12.0 statistical software (Stata Corp., College Station, TX), and all P values were two-tailed, the test level was 0.05. Result: 97 articles were obtained from the database search, and 5 articles obtained from other sources. 8 articles involving 11,169 participants were included. Most studies were considered moderate quality. A statistically significant association between metformin use and decreased mortality of COVID-19 patients was found (OR 0.53, 95%CI: 0.34, 0.83, P=0.005, I2=77%). In the subgroup analyses, home-use of metformin was also associated with a reduced risk of mortality (OR 0.54, 95%CI: 0.35, 0.84, P=0.006, I2=66%), and one study reporting in-hospital use did not find reduced mortality among COVID-19 patients taking metformin (OR 1.65, 95%CI: 0.71, 3.86, P=0.247). For sample size >1,000, no statistically significant reduced risk of mortality (OR 0.84, 95%CI: 0.57, 1.26, P=0.41, I2=73%) was found, however, for sample ≤1,000, a statistically significant reduced risk of mortality (OR 0.29, 95%CI: 0.19, 0.44 P<0.00001, I2=0%) was found. Sensitivity analysis by change fixed-effect models to random-effect models and by omitting each study at a time confirmed the relative stability of the result. Begg’s test (z=0.37, P=0.711) and Egger’s test (t=-1.98, P=0.096) did not detect a significant risk of publication bias. Conclusion: The current meta-analysis demonstrates that metformin use is associated with decreased mortality for COVID-19 diabetic patients. However, only one study investigating the in-hospital use of metformin. More high-quality original studies are needed to further explore the association between metformin use and mortality risk of COVID-19.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.111 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.007 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".