DPP-4 and GLP-1 drugs reduced COVID-19 hospitalizations by 21% in 26,000 older diabetic Canadians | Research

The takeaway

In 40,972 older Canadians with T2DM, DPP4i/GLP-1RA use was associated with 21% lower COVID-19 hospitalization (RR 0.79, p<0.001) versus SGLT2i/SU, with no difference in infection risk but a trend toward fewer cardiovascular events.

21% less COVID hospitalization
Incretin-based drugs (DPP4i/GLP-1RA) reduced COVID-19 hospitalization by 21% in older diabetics—likely through anti-inflammatory mechanisms rather than infection prevention

What the researchers found

COVID-19 infection: RR 0.99 (NS). Hospitalization: RR 0.79 (p<0.001), RD -6.72%. Major CV events: RR 0.73 (borderline p=0.05). 26,485 DPP4i/GLP-1RA vs 14,487 SGLT2i/SU. Age ≥66. 2020-2021.

Why it matters

COVID-19 disproportionately affects diabetic patients. Finding that incretin-based drugs reduce severe outcomes (hospitalization) suggests their anti-inflammatory properties provide protection during acute illness.

How the study worked

Population-based cohort study. Ontario, Canada. ≥66 years with T2DM on metformin + COVID-19 tested (Jan 2020-Jul 2021). Weighted risk differences and relative risks.

What this study cannot tell us

91% were DPP4i users (not GLP-1RA)—effects may be primarily DPP4i-driven. Observational. 2020-2021 pandemic era (pre-vaccination for many). Older Canadian population.

How to read the evidence

Population-based cohort with appropriate comparator. Pandemic-era data with inherent limitations.

When this study was published

Published in 2025; pandemic data 2020-2021.

The bigger picture

GLP-1 drugs' anti-inflammatory effects may protect against severe outcomes from various infections, not just COVID-19. This is consistent with their known immune-modulating properties.

Questions still open

Was the hospitalization benefit from DPP4i, GLP-1RA, or both?
Would GLP-1 drugs protect against severe outcomes from other respiratory infections?
Should diabetic patients continue GLP-1 drugs during acute COVID-19?

Common questions

Do diabetes drugs affect COVID-19 outcomes?

This study found patients on incretin-based diabetes drugs (DPP4 inhibitors and GLP-1 drugs) had 21% fewer COVID-19 hospitalizations than those on other diabetes medications. The drugs did not prevent infection itself, but appeared to reduce the severity of disease when infection occurred.

Should I keep taking my diabetes drugs if I get COVID?

Based on this evidence, yes—especially incretin-based drugs. Their anti-inflammatory properties may actually protect against severe COVID-19 outcomes. Always consult your doctor about medication management during acute illness.

Read the original research

Association between dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists and COVID-19 infection and adverse outcomes: a cohort study.

BMJ open diabetes research & care, 13(4)

View on PubMed ↗Publisher’s paper ↗

Citation

Thompson, Wade; Yu, Bing; Porter, Joan; Fang, Jiming; Ferreira-Legere, Laura E; Austin, Peter C; Jackevicius, Cynthia A; Ross, Heather; Lee, Douglas S; Weisman, Alanna; Farkouh, Michael E; Gershon, Andrea S; Atzema, Clare L; Kwong, Jeffrey C; Ha, Andrew; Džavík, Vladimír; Udell, Jacob A. (2025). Association between dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists and COVID-19 infection and adverse outcomes: a cohort study.. BMJ open diabetes research & care, 13(4). https://doi.org/10.1136/bmjdrc-2024-004677