Use of oral anti-diabetic drugs and risk of hospital and intensive care unit admissions for infections

• Authors: Jeeyon Rim, Duke University, Durham, NC, USA; Julia Gallini, Department of Veterans Affairs, Atlanta VAMC, Atlanta, GA, USA; Christine Jasien, Department of Veterans Affairs, Atlanta VAMC, Atlanta, GA, USA; Xiangqin Cui, Emory University; Lawrence Phillips, Emory University; Aaron Trammell, Emory University; Ruxana T Sadikot, University of Nebraska Medical Center, Omaha, NE, USA
• Journal Title: AMERICAN JOURNAL OF THE MEDICAL SCIENCES
• Volume: Volume 364, Number 1
• Publisher: ELSEVIER SCIENCE INC | 2022-06-10, Pages 53-58
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.amjms.2022.01.003
• Subjects: Health Sciences, Medicine and Surgery; Engineering, Biomedical; Biology, Veterinary Science; Biology, Biostatistics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; Infections; Infection; Oral anti-diabetic drugs; Glucose lowering drugs; PEPTIDASE-4 INHIBITORS; ACTIVATION; PNEUMONIA; OUTCOMES; AMPK; METAANALYSIS; MORTALITY; CD26

Abstract

Background: Sepsis is one of the leading causes of hospital mortality, and diabetes is a risk factor for the development of infections. Although strong evidence has shown an association between metformin and reduced risk of infections, the risk of developing infections with newer classes of oral anti-diabetic drugs (OADs) has been less certain. Our study aims to examine the association between outpatient OAD use and hospital admissions for infections. Methods: The study cohort included 1.39 million adults with diabetes utilizing the Veterans Health Affairs Corporate Data Warehouse. Multivariate logistic regression was used to estimate the effect of each drug class on hospital admission for infection while adjusting for covariates. Results: After adjusting for covariates, those who took metformin during the study period had 3.3% lower odds of hospital admission for infection compared to those who were never on metformin (OR 0.97, 95% CI 0.95-0.98). OADs that were associated with a statistically significant increased odds of being admitted included meglitinides (OR 1.22, 95% CI 1.07-1.38), SGLT2 inhibitors (OR 1.16, 95% CI 1.08-1.24), alpha-glucosidase inhibitors (OR 1.09, 95% CI 1.04-1.15), and DPP4 inhibitors (OR 1.04, 95% CI 1.01-1.06). Conclusions: Metformin was associated with lower odds of hospital admission for infection while meglitinides, SGLT2 inhibitors, alpha-glucosidase inhibitors, and DPP4 inhibitors were associated with higher odds of admission for infection.