{
  "abstract": "Introduction People with type 2 diabetes (T2DM) have an elevated risk of adverse outcomes from COVID-19. Dipeptidyl peptidase-4 inhibitors (DPP4is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) might have favorable effects on COVID-19 outcomes.Research design and methods We conducted a population-based cohort study in Ontario, Canada. We compared the risk of both COVID-19 infection as well as adverse outcomes between users of DPP4i or GLP1RA and users of sodium-glucose cotransporter-2 inhibitors (SGLT2is) or sulfonylureas (SUs). The study population was persons ≥66 years with T2DM taking metformin who had ≥1 COVID-19 PCR test between January 2020 and July 2021. We compared (1) COVID-19 infection and (2) adverse outcomes at 30 days among COVID-19 positive patients (major cardiovascular (CV) events, hospitalizations, intensive care unit admission, all-cause mortality, venous thromboembolism, mechanical ventilation). We reported weighted risk differences (RDs) and relative risks (RRs).Results There were 26,485 DPP4i/GLP1RA users (mean age 76, 47% female, 91% DPP4i users) and 14,487 SGLT2i/SU users (mean age 75, 39% female, 65% SGLT2i users). The weighted rate of COVID-19 infection in DPP4i/GLP1RA users was 10.3% compared with 10.4% among SGLT2i/SU users (weighted RD −0.06, 95% CI −0.79 to 0.66; RR 0.99, 95% CI 0.93 to 1.07). Among COVID-19 positive patients, the weighted RD for all-cause hospitalization for DPP4i/GLP1RA users versus SGLT2i/SU users was −6.72% (95% CI −3.02 to −10.4) and the adjusted weighted RR was 0.79 (95% CI 0.70 to 0.89). For major CV events, the weighted RD was −1.91% (95% CI −4.00 to 0.18) and RR 0.73 (95% CI 0.54 to 1.00).Conclusions DPP4i/GLP1RA use was not associated with reduced risk of COVID-19 infection compared with SGLT2i/SU use. DPP4i/GLP1RA use was associated with reduced risk of 30-day hospitalization among COVID-19 positive older adults and a possible trend towards a lower associated risk of CV events.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Women's College Research Institute, Toronto, Ontario, Canada"
      ],
      "name": "Wade Thompson"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"
      ],
      "name": "Bing Yu"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"
      ],
      "name": "Joan Porter"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"
      ],
      "name": "Jiming Fang"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"
      ],
      "name": "Laura E Ferreira-Legere"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Sunnybrook Research Institute, Toronto, Ontario, Canada"
      ],
      "name": "Peter C Austin"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Western University of Health Sciences, Pomona, California, USA"
      ],
      "name": "Cynthia A Jackevicius"
    },
    {
      "affiliations": [
        "Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada",
        "Toronto General Hospital Research Institute, Toronto, Ontario, Canada"
      ],
      "name": "Heather Ross"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Douglas S Lee"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Alanna Weisman"
    },
    {
      "affiliations": [
        "Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada",
        "Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Michael E Farkouh"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Sunnybrook Research Institute, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Andrea S Gershon"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Sunnybrook Research Institute, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Clare L Atzema"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada",
        "Public Health Ontario, Toronto, Ontario, Canada",
        "Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada",
        "University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Jeffrey C Kwong"
    },
    {
      "affiliations": [
        "Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada",
        "Toronto General Hospital Research Institute, Toronto, Ontario, Canada"
      ],
      "name": "Andrew Ha"
    },
    {
      "affiliations": [
        "Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Vladimír Džavík"
    },
    {
      "affiliations": [
        "Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Jacob A Udell"
    }
  ],
  "title": "Association between dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists and COVID-19 infection and adverse outcomes: a cohort study",
  "uid": "7b0f002f-6a58-571a-886b-3349ebf805ba"
}