Can metformin reduce mortality in diabetic individuals with severe COVID-19?

The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a heavier impact on certain subgroups of the population, with notable risk factors being diabetes, obesity, hypertension, cardiovascular disease and advanced age.

A new study by researchers in China and the U.S. describes a round-up of the effects of commonly used hypoglycemic drugs on the outcomes of COVID-19 in diabetic patients.

The role of inflammation
There is a consensus that an exaggerated immune response underlies the progression of COVID-19 to severe and critical stages. This is the result of the uncontrolled release of high levels of inflammatory mediators or cytokines into the tissues, causing inflammatory damage to multiple organs. The presence of what is known as a “cytokine storm” thus correlates with adverse outcomes in COVID-19.

While diabetes has been established to be a risk factor for short-term mortality in hospitalized COVID-19 patients, the role of the drugs used to treat diabetes is less well known. The drugs in common use include metformin, dipeptidyl-peptidase 4 inhibitors (DPP-4i), sulfonylurea, glinides, sodium-glucose co-transporter 2 inhibitors (SGLT-2i),
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