Effect of the Combination of Sitagliptin and Insulin in Comparison to Insulin on Mortality in Hospitalized Patients with SARs-CoV-2 Infection in Bhumibol Adulyadej Hospital

Abstract

Introduction: The COVID-19 virus is a coronavirus that can spread rapidly and causes severe inflammation of the respiratory system leading to respiratory failure and death. Approximately one-third of patients who die from COVID-19 infection are also diagnosed with diabetes. Moreover, fifteen to thirty – five percent of patients infected with COVID-19, who are admitted to the in-patient department Bhumibol Adulyadej Hospital, have hyperglycemia. Diabetes is, therefore, associated with COVID-19 infection and may be a major comorbidity in the rapid spread of the virus. Sitagliptin is an oral DPP-4 inhibitor used for the treatment of patients with type 2 diabetes and is effective in lowering HbA1c levels. Sitagliptin does not cause weight gain, and there are very few side effects. Therefore, sitagliptin is commonly used in the patients with type 2 diabetes.

Objectives: To comparison the effect sitagliptin plus insulin with standard of care (insulin alone) on the mortality rate and clinical improvement in COVID-19 patients with type 2 diabetes.

Methods: This study was a randomized controlled trial, open-label, which collected data from the patients with diabetes or diagnosed with diabetes while receiving treatment for COVID-19 at Bhumibol Adulyadej Hospital during May-September 2021. Patients were randomized to receive sitagliptin plus insulin or insulin alone and was follow-up for a period of 1 month. Patient baseline data, laboratory findings and mortality rate were analyzed by comparing the relationships between various factors. Data were analyzed using Chi-square test or T-test.

Results: A total of 66 patients were eligible and enrolled into study, of which 9 died, 4 (12.1%) of the patients treated with sitagliptin plus insulin and 5 people received insulin. From the analysis, it was found that patients treated with sitagliptin plus insulin were less likely to die compared with patients treated with insulin, but the difference was not statistically significance. (Odds ratio, 0.772 95% CI; 0.188 – 3.175; p-Value = 0.720).

Conclusion: In type 2 diabetic patients infected with COVID-19 admitted to the in-patient department, Bhumibol Adulyadej Hospital, there was no statistical differences in mortality rate and clinical improvement between the sitagliptin-treated group and the standard of care.