Aspirin reduces diabetes risk during Covid-19, but not without side effects

Aspirin reduces diabetes risk during Covid-19, but not without side effects

New research suggests that taking a daily aspirin may reduce your risk of diabetes, particularly during the Covid-19 pandemic, by reducing inflammation, but not without compromise.

In a study recently published in the journalNPJ -Metabolic Health and DiseaseA group of researchers examined whether daily low-dose aspirin reduced the risk of new-2 diabetes (T2D) associated with coronavirus disease 2019 (COVID-19).

background

T2D affects over 500 million people worldwide and its incidence rose sharply during the Covid-19 pandemic. Several factors, including stress, poor dietary habits, reduced physical activity and limited access to healthcare, may have contributed to this increase in cases.

Experimental research suggests that inflammation plays a key role in disrupting insulin function, leading to interest in anti-inflammatory treatments for prevention. Aspirin has anti-inflammatory effects that may help regulate blood sugar levels alongside its cardiovascular benefits. However, most results to date are from controlled studies in older adults, and further research is needed to understand how aspirin affects T2D in everyday life.

About the study

Aspirin's dual anti-inflammatory pathways. Low-dose aspirin blocks prostacyclin production and triggers the release of anti-adhesive nitric oxide, while high doses inhibit the NF-κB cascade - both mechanisms potentially disrupt the development of diabetes.

The present longitudinal cohort study was conducted using electronic health records from the Cooperative of General Practitioners (COMGE) - a healthcare network of the Italian Ministry of Health in Naples. The ComeGen database contains clinical information on over 200,000 adults. Researchers collected data from January 1, 2018 to December 31, 2022 among adults aged 18 and over. Adults were eligible if they had no previous diagnosis of T2D, chronic kidney disease, or cardiovascular events, nor were they using aspirin before 2018.

The primary exposure was initiation of daily low-dose aspirin therapy (100 mg) and the primary outcome was a new diagnosis of T2D confirmed by diagnostic codes and prescriptions. Researchers confirmed CoVID-19 infections using Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing data from the official registry of the Campania Region.

To ensure accurate comparisons between aspirin users and nonusers, researchers matched participants based on factors such as age, gender, body mass index (BMI), prediabetes status, and use of blood pressure or lipid-lowering medications. They used Cox regression to track the time until new cases of diabetes appeared and plotted overall risk trends using Kaplan-Meier curves. Bleeding events were monitored throughout the study and classified as major, intermediate, or minor.

The study design also enabled reliable detection of minor hepatic bleeding, which is often missed in clinical trials but can significantly impact patients. All results were considered statistically significant if P values ​​were less than 0.05, and analysis was performed using R software (version 4.4.0).

Study results

Older, higher-risk participants dominated the cohort. Before the match, aspirin users averaged 76 years of age with 40% prediabetes and 74% statin use, highlighting a population already facing metabolic challenges.

Of 247,975 eligible individuals in the ComeGen database, 35,525 met the inclusion criteria. After applying 1:1 propensity score matching, 4,139 people receiving a low-dose aspirin were compared with an equal number of matched nonusers. The matched groups were similar in age, sex, BMI, and baseline comorbidities, providing reliable comparisons.

During the observation period, 999 new cases of T2D were reported. Among aspirin users, the incidence rate was 15.9 per 1,000 person-years, while in the control group it was 32 per 1,000 person-years. Cox regression analysis revealed that aspirin therapy was associated with a 52% reduction in T2D risk (hazard ratio [HR] = 0.48; 95% confidence interval [CI]: 0.42–0.45; p < 0.001). The Kaplan-Meier curves confirmed that the divergence in T2D risk became significant after the second year of aspirin use and continued to increase over time.

When the data was split into pre-pandemic and Covid-19 pandemics, the protective effect remained strong. Before Covid-19, aspirin users had a 29% reduced risk of developing T2D (HR = 0.71; 95% CI: 0.56-0.89). During the Covid-199 period, risk reduction increased to 62% (HR = 0.38; 95% CI: 0.32-0.35). The Kaplan-Meier analysis revealed earlier and more pronounced separation of risk curves during the pandemic, suggesting that aspirin's anti-inflammatory properties had increased relevance amid CoVID-19-related immune activation.

The safety analysis included 8,278 participants equally divided between aspirin users and nonusers. Major bleeding events occurred in 0.3% of aspirin users compared to 0.1% in the control group. Moderate bleeding rates were 8.3 versus 4.2 events per 1,000 person-years, and minor bleeding, including hematuria, was slightly more common in the aspirin group (6.7 versus 4.9 per 1,000 person-years). While aspirin increased bleeding risks, the rates were consistent with previous studies and most events were not life-threatening.

These results suggest that low-dose aspirin significantly reduces the risk of New 2 diabetes, particularly during the Covid-19 pandemic. This effect highlights the inflammatory basis of diabetes pathogenesis in the context of viral infection and supports further investigation of targeted anti-inflammatory strategies in high-risk populations.

Conclusions

Pancreatic Ace2 receptor controversy. The paper determines whether SARS-COV-2 directly infects human insulin-producing cells, suggesting that inflammation may drive diabetes independently of viral invasion.

In conclusion, this real-world cohort study using Comgen data shows that daily low-dose aspirin significantly reduces the incidence of type 2 diabetes (T2D), particularly during the Covid-19 pandemic. The results strengthen the hypothesis that inflammation is a key driver of CoVID-19-related metabolic disorders and demonstrate the potential of aspirin in reducing this risk. However, the associated increase in bleeding events requires caution and individual risk-benefit assessment.

While the study is robust, the authors acknowledge limitations including the lack of data on inflammatory markers, lifestyle changes and CoVID-19 vaccination status. These findings should not lead to widespread use of aspirin for the prevention of diabetes, but rather suggest promising therapeutic directions.

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