Insulin Treatment Is Associated with Increased Mortality in Patients with COVID-19 and Type 2 Diabetes

Cell Metab. 2021 Jan 5;33(1):65-77.e2. doi: 10.1016/j.cmet.2020.11.014. Epub 2020 Nov 23.


COVID-19 caused by SARS-COV-2 infection can lead to multi-organ injuries and significant mortality in severe and critical patients, especially among those individuals with type 2 diabetes (T2D) as a comorbidity. While attenuated mortality was observed with aggressive glucose control, it was unclear whether therapeutic regimens including insulin treatment were beneficial for patients with COVID-19 and T2D. This retrospective study investigated 689 patients with COVID-19 and T2D from a cohort of 3,305 cases from Wuhan, China. Unexpectedly, we found that insulin treatment for patients with COVID-19 and T2D was associated with a significant increase in mortality (27.2% versus 3.5%; adjusted HR, 5.38 [2.75-10.54]). Further analysis showed that insulin treatment was associated with enhanced systemic inflammation and aggravated injuries of vital organs. Therefore, insulin treatment for patients with COVID-19 and T2D should be used with caution.

Keywords: COVID-19; antidiabetic treatment; glycemic control; inflammation; insulin; mortality; type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • COVID-19 / complications
  • COVID-19 / drug therapy*
  • COVID-19 / metabolism
  • COVID-19 / mortality*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / mortality*
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Insulins / adverse effects*
  • Insulins / metabolism
  • Insulins / therapeutic use
  • Male
  • Middle Aged
  • Retrospective Studies


  • Insulins