Scientists examine potential uses of diabetes drug in the fight against COVID-19
Researchers at Weill Cornell Medicine – Qatar (WCM-Q) have examined whether a common diabetes drug could provide some protection against hospitalization and death in patients with COVID-19.
In the article, Dr. Samson Mathews Samuel, Elizabeth Varghese, and lead investigator Dr. Dietrich Büsselberg outlined the possibility of re-purposing metformin as a potential drug that can protect against and treat severe effects of the novel coronavirus.
Diabetic patients already have a compromised immune response and are more prone to severe bacterial and viral infections, require more recovery time, and present longer-lasting adverse effects than their non-diabetic counterparts.
Proper management of controlled blood glucose levels is closely related to the body's ability to regulate immune and inflammatory responses and fight infections in chronic diabetic patients. It is known that COVID-19 is potentially more severe in diabetic patients, with a higher risk of hospitalization and death. The virus’ disease severity and the risk of mortality in diabetic patients can be correlated to hyperglycemia, diabetes-associated endothelial dysfunction, and hyperactive inflammatory and immune responses.
Dr. Samuel, the first author of the article, emphasized the need for proper control of blood glucose levels in diabetic COVID-19 patients. He said: "Additionally, COVID-19 infections can lead to new-onset diabetes in coronavirus infected individuals who previously did not have a diagnosis of diabetes. This new-onset diabetes also occurs among infected children. Hence, it is necessary to monitor the blood glucose levels of COVID-19 patients and remain vigilant regarding possible signs of hyperglycemia.”
The drug metformin, which is already proven to be safe and well-tolerated, not only regulates blood sugar levels and increases insulin sensitivity – in common with other anti-diabetic drugs – but also could inhibit the virus from binding to the cells, reduce endothelial dysfunction, and change how the body’s inflammatory and immune systems respond, to the benefit of the patient. The researchers surmise that those diabetic patients taking metformin before they catch the virus are less likely to be hospitalized or to die.
Dr. Büsselberg, professor of physiology and biophysics at WCM-Q, and the team supervisor suggested that prescribed metformin could offer some protection for diabetics and even people with associated comorbidities. He said: "It is well-established and accepted that metformin protects against diabetes-related adverse effects. Now evidence also points to the beneficial effects of metformin in the treatment of COVID-19 patients. Studies reported that patients on metformin are less likely to develop severe symptoms and require hospitalization, and have higher chances of survival. Hence, by offering metformin to people with diabetes, it may reduce serious complications from COVID-19. Whether metformin can be administered to non-diabetic COVID-19 patients and whether this would be beneficial is yet to be answered. However, it must be noted that metformin may not be an appropriate choice in patients with severe respiratory distress, kidney impairment, or heart failure, and hence caution must be exercised before drug selection and administration.”
The researchers emphasized that everyone hopes that the current vaccines are successful. However, the emergence of highly transmissible coronavirus mutants has raised concerns that these variants could evade the body's immune response and threaten the vaccine's efficiency. The immediate need in this battle against COVID-19 is an effective drug that can successfully treat the disease, improve recovery, and reduce the long-term adverse effects of COVID-19. While effective vaccines and efficient vaccination programs are at the forefront in the fight against COVID-19, drugs such as metformin, which are routinely used for other pathological conditions, must not be overlooked in terms of their efficiency to treat COVID-19. However, there are questions still to be answered, though, not least, the long-term effect of metformin on COVID-19 patients.
The study has also raised other questions about metformin's potential, such as whether people with diabetes currently using metformin are more resistant to COVID-19 than those on other hyperglycemic medications and whether metformin could be used as a therapy for both diabetics and non-diabetics after they have been diagnosed with the virus.
Dr. Büsselberg and his team are supported by NPRP grant NPRP 11S‐1214‐170101 from the Qatar National Research Fund, a member of Qatar Foundation. The conclusions reached in the publication are solely the responsibility of the authors.
The study is entitled 'Therapeutic Potential of Metformin in COVID-19: Reasoning for its Protective Role,' and has been published in the high-impact journal Trends in Microbiology. It can be read at https://www.cell.com/trends/microbiology/fulltext/S0966-842X(21)00063-9.