PMID- 33232684 OWN - NLM STAT- MEDLINE DCOM- 20210122 LR - 20240401 IS - 1538-9375 (Electronic) IS - 1525-8610 (Print) IS - 1525-8610 (Linking) VI - 22 IP - 1 DP - 2021 Jan TI - Metformin is Associated with Decreased 30-Day Mortality Among Nursing Home Residents Infected with SARS-CoV2. PG - 193-198 LID - S1525-8610(20)30924-5 [pii] LID - 10.1016/j.jamda.2020.10.031 [doi] AB - OBJECTIVES: The COVID-19 pandemic presents an urgent need to investigate whether existing drugs can enhance or even worsen prognosis; metformin, a known mammalian target of rapamycin (m-TOR) inhibitor, has been identified as a potential agent. We sought to evaluate mortality benefit among older persons infected with SARS-CoV-2 who were taking metformin as compared to those who were not. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 775 nursing home residents infected with SARS-CoV-2 who resided in one of the 134 Community Living Centers (CLCs) of the Veterans Health Administration (VHA) during March 1, 2020, to May 13, 2020, were included. METHODS: Using a window of 14 days prior to SARS-CoV-2 testing, bar-coded medication administration records were examined for dispensing of medications for diabetes. The COVID-19-infected residents were divided into 4 groups: (1) residents administered metformin alone or in combination with other medications, (2) residents who used long-acting or daily insulin, (3) residents administered other diabetes medications, and (4) residents not administered diabetes medication, including individuals without diabetes and patients with untreated diabetes. Proportional hazard models adjusted for demographics, hemoglobin A1c, body mass index, and renal function. RESULTS: Relative to those not receiving diabetes medications, residents taking metformin were at significantly reduced hazard of death [adjusted hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.28, 0.84] over the subsequent 30 days from COVID-19 diagnosis. There was no association with insulin (adjusted HR 0.99, 95% CI 0.60, 1.64) or other diabetes medications (adjusted HR 0.71, 95% CI 0.38, 1.32). CONCLUSIONS AND IMPLICATIONS: Our data suggest a reduction in 30-day mortality following SARS-CoV-2 infection in residents who were on metformin-containing diabetes regimens. These findings suggest a relative survival benefit in nursing home residents on metformin, potentially through its mTOR inhibition effects. A prospective study should investigate the therapeutic benefits of metformin among persons with COVID-19. CI - Published by Elsevier Inc. FAU - Lally, Michelle A AU - Lally MA AD - Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. FAU - Tsoukas, Philip AU - Tsoukas P AD - Department of Medicine and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. FAU - Halladay, Christopher W AU - Halladay CW AD - Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA. FAU - O'Neill, Emily AU - O'Neill E AD - Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA. FAU - Gravenstein, Stefan AU - Gravenstein S AD - Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. FAU - Rudolph, James L AU - Rudolph JL AD - Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. Electronic address: James.Rudolph@va.gov. LA - eng GR - C19 20-213/HX/HSRD VA/United States GR - P01 AG027296/AG/NIA NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20201026 PL - United States TA - J Am Med Dir Assoc JT - Journal of the American Medical Directors Association JID - 100893243 RN - 0 (Hypoglycemic Agents) RN - 9100L32L2N (Metformin) SB - IM MH - Aged MH - COVID-19/*mortality/*prevention & control MH - Female MH - Humans MH - Hypoglycemic Agents/*therapeutic use MH - Male MH - Metformin/*therapeutic use MH - Middle Aged MH - *Nursing Homes MH - Prospective Studies MH - SARS-CoV-2 PMC - PMC7586924 OTO - NOTNLM OT - COVID-19 OT - Nursing home OT - diabetes OT - metformin EDAT- 2020/11/25 06:00 MHDA- 2021/01/23 06:00 PMCR- 2020/10/26 CRDT- 2020/11/24 20:07 PHST- 2020/08/25 00:00 [received] PHST- 2020/10/19 00:00 [revised] PHST- 2020/10/23 00:00 [accepted] PHST- 2020/11/25 06:00 [pubmed] PHST- 2021/01/23 06:00 [medline] PHST- 2020/11/24 20:07 [entrez] PHST- 2020/10/26 00:00 [pmc-release] AID - S1525-8610(20)30924-5 [pii] AID - 10.1016/j.jamda.2020.10.031 [doi] PST - ppublish SO - J Am Med Dir Assoc. 2021 Jan;22(1):193-198. doi: 10.1016/j.jamda.2020.10.031. Epub 2020 Oct 26.