Metformin is a drug that improves insulin sensitivity and lowers blood glucose levels. Metformin is prescribed for patients with type 2 diabetes mellitus (DM2), prediabetes, and polycystic ovary syndrome, in which 75% of cases also have impaired insulin sensitivity (insulin resistance).
Criteria of Prediabetes
Prediabetes is when blood glucose levels are already higher than average but not as high as in diabetes. The cause of prediabetes is insulin resistance, which increases the risk of diabetes progression. Without proper treatment, 25-50% of prediabetes patients progress to diabetes. To prevent the passage of prediabetes, patients are advised to reduce their weight. Metformin may also contain or delay the progression of prediabetes.
Prediabetes is diagnosed when any of the following criteria are met:
- fasting plasma glucose 100 to 125 mg/dl (5.6 to 6.9 mmol/l);
- glucose level 2 hours after taking 75 g of glucose (glucose tolerance test) from 140 to 199 mg/dl (7.8-11 mmol/l);
- glycated hemoglobin (A1c) 5.7 to 6.4% (39-47 mmol/mol).
Criteria of Polycystic Ovarian Syndrome
Polycystic ovary syndrome (PCOS) occurs in 12% of women of reproductive age. Treatment for PCOS is symptomatic. One treatment is metformin, which increases insulin sensitivity, induces ovulation, regulates the menstrual cycle, and reduces weight.
In the absence of thyroid disease, excess prolactin, and congenital adrenal hyperplasia, PCOS is diagnosed when 2 of 3 of the following criteria are present:
- oligomenorrhea/amenorrhea;
- clinical or biochemical signs of hyperandrogenism;
- polycystic ovarian morphology on ultrasound.
Benefits of Metformin in COVID-19
Patients with prediabetes and PCOS are at increased risk for severe COVID-19. Several studies have shown that in diabetic patients taking metformin before contracting coronavirus, metformin reduced the severity of COVID-19, acute respiratory distress syndrome, and ICU admissions. The protective effect of metformin can be explained by the fact that metformin attenuates endothelial dysfunction, prevents the penetration of the virus into the cell, and attenuates inflammatory responses during COVID-19, which can lead to dysfunction of internal organs.
Metformin and COVID-19: A Study in Patients with Prediabetes and PCOS
American scientists investigated how taking metformin before coronavirus infection affects the severity of COVID-19 in patients with prediabetes or PCOS.
The scientists used clinical data from about 3,700 PCOS patients and nearly 70,700 prediabetic patients who tested positive for the coronavirus. The experimental group took metformin before COVID-19, and the control group – other medications not associated with prediabetes or PCOS.
Patients in the control group received the following:
- Levothyroxine – a synthetic thyroid hormone drug used to treat hypothyroidism and other thyroid conditions. Levothyroxine is not a successful therapeutic intervention for COVID-19.
- Ondansetron is an antiemetic drug used by patients undergoing radiation or chemotherapy. Ondansetron reduces all-cause mortality in patients with COVID-19 when given ondansetron after COVID-19 onset.
Study Results
Metformin did not reduce the severity of COVID-19 for PCOS patients compared with levothyroxine. However, metformin reduced the incidence of mild to moderate COVID-19 compared with ondansetron.
Metformin reduced the incidence of mild to moderate COVID-19 compared with levothyroxine for patients with prediabetes. Compared to ondansetron, metformin reduced the incidence of mild to moderate COVID-19 and also reduced COVID-19 mortality. In addition, for patients with prediabetes and comorbid chronic respiratory disease or hypertension, metformin reduced the incidence of severe COVID-19.
Conclusion
Patients with prediabetes and PCOS have an increased risk of severe COVID-19. The reason is that elevated blood glucose levels cause endothelial dysfunction and reduce the body’s ability to regulate immune and inflammatory responses. Metformin taken before coronavirus infection reduces the severity of COVID-19 in patients with prediabetes and PCOS.
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Reference
Metformin is associated with reduced COVID-19 severity in patients with prediabetes
