Diabetes Metab J.  2021 Mar;45(2):251-259. 10.4093/dmj.2020.0206.

Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19

• Rhee SY
• Lee J
• Nam H
• Kyoung DS
• Shin DW
• Kim DJ

• KMID: 2514201
• DOI: http://doi.org/10.4093/dmj.2020.0206

Abstract

Background
Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM).
Methods
As of May 2020, analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Insurance Review and Assessment Service (HIRA) database in Korea. Using this dataset, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Additionally, we validated the results using the National Health Insurance Service (NHIS) of Korea dataset.
Results
Totally, data of 67,850 subjects were accessible in the HIRA dataset. Of these, 5,080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 (95% confidence interval [CI], 0.135 to 0.971), and that for RAS blockade users was 0.599 (95% CI, 0.251 to 1.431). These findings were consistent with the analysis based on the NHIS data using 704 final subjects. The adjusted odds ratio for severe treatment among DPP-4i users was 0.303 (95% CI, 0.135 to 0.682), and that for RAS blockade users was 0.811 (95% CI, 0.391 to 1.682).
Conclusion
This study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19.

Keyword

Angiotensin-converting enzyme 2; COVID-19; COVID-19 drug treatment; Diabetes mellitus; Dipeptidyl peptidase 4

Figure

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  Fig. 1. Flow chart of the selection of study subjects based on the data from the National Health Insurance Review and Assessment Service of Korea. COVID-19, coronavirus disease 2019; DM, diabetes mellitus; ICU, intensive care unit.

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  Fig. 2. Flow chart of the selection of study subjects based on the National Health Information Database (NHID)-COVID database from the National Health Insurance service of Korea. COVID-19, coronavirus disease 2019; DM, diabetes mellitus; ICU, intensive care unit.

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