Dr. Prashant Vedwan (Emergency Medicine) needs a second opinion on this medical case.
Sitagliptin for Diabetic Patients with COVID-19
According to recent research, it was found that Sitagliptin, a Diabetes drug improves survival in diabetes patients with COVID-19. The findings have led to a new randomized, placebo-controlled trial of sitagliptin. Sitagliptin – a drug used to lower blood sugar in type 2 diabetes benefits patients hospitalized with COVID-19. It is known as DPP-4 inhibitors and prescribed to an estimated 15 to 20 percent of patients with type 2 diabetes.
It acts by lowering blood sugar by blocking the receptor for the enzyme DPP-4 thereby causing an increase in insulin production. Patients who were given sitagliptin in addition to insulin had a mortality rate of 18 percent as compared with 37 percent in matched patients receiving only insulin. The study the researchers conducted involved seven Italian hospitals during the first surge of COVID cases last spring. Based on sitagliptin’s mechanism of action, researchers believe it could also work in non-diabetic patients with COVID.
Recent studies suggest that DPP-4 may also help SARS-CoV-2 get into respiratory cells. In addition to blocking DPP-4, sitagliptin has anti-inflammatory effects, reducing the production of the cytokine IL-6, which is known to contribute to the “cytokine storm” that can cause organ complications in COVID-19. In addition to that, sitagliptin may also help to keep the blood sugar down. Studies previously have shown that diabetic patients with worse glycemic control have a worse outcome when it comes to infection.
338 patients with type 2 diabetes and COVID-19 pneumonia were consecutively admitted to seven academic hospitals in northern Italy from March 1 through April 30, 2020. 169 of these were given only IV insulin for their type 2 diabetes (the standard of care) and served as controls; the rest 169 received sitagliptin in addition to IV insulin. The two groups of patients were matched for age and sex, and their outcomes were analyzed retrospectively. The other standard measures and use of treatments were similar in the two groups. Compared with the controls, patients receiving sitagliptin had reduced mortality and were more likely to improve clinically. The team is looking forward to treating patients with the condition in the future.