Patients with type 2 diabetes are at increased risk of COVID-19 outcomes. This may be because of the dysregulated inflammatory responses. Glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and pioglitazone, are now well established in having anti-inflammatory effects. The current study published in ‘Diabetes’ showed that the use of glucose-regulating medications, such as GLP-1R agonists, DPP-4 inhibitors, or pioglitazone improves COVID-19 outcomes for patients with T2DM.

In a multinational retrospective cohort study, researchers used the TriNetX COVID-19 Research Network of 56 large health care organizations to examine these medications in relation to the incidence of hospital admissions, respiratory complications, and mortality within 28 days after a COVID-19 diagnosis. Of the 68,959,064 patients in the database, 1.6% of patients without T2DM and 6.5% of patients with T2DM died within 28 days after the first record of COVID- 19. After matching for age, sex, race, ethnicity, BMI, and significant comorbidities, use of GLP- 1R agonists and/or pioglitazone were associated with significant reductions in hospital admissions.The use of GLP-1R agonists was also associated with reductions in respiratory complications and incidence of mortality).The use of DPP-4 inhibitors was associated with a reduction in respiratory complications and continued use of DPP-4 inhibitors after hospitalization was associated with a decrease in mortality compared with those who discontinued the use.

This is the first study to provide evidence that patients with T2DM treated with GLP-1R agonists, and to a lesser extent pioglitazone and DPP-4 inhibitors, within the 6 months preceding the diagnosis of COVID-19 demonstrated better outcomes than patients not treated with these medications.