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dc.contributor.authorLye, David Chienen
dc.contributor.authorHtun, Htet Linen
dc.contributor.authorYeo, Tsin Wenen
dc.contributor.authorTam, Clarence C.en
dc.contributor.authorPang, Junxiongen
dc.contributor.authorLeo, Yee Sinen
dc.identifier.citationHtun, H. L., Yeo, T. W., Tam, C. C., Pang, J., Leo, Y. S., & Lye, D. C. (2018). Metformin use and severe dengue in diabetic adults. Scientific Reports, 8(1), 3344-.en
dc.description.abstractDiabetes mellitus is a risk factor for severe dengue in adults, but few studies have examined the association between metformin use and disease severity in dengue. In addition to its effect on glucose control, metformin has been associated with pleiotropic properties in preclinical studies. Using a cohort of laboratory-confirmed adult (≥21 years) dengue patients with diabetes mellitus admitted to Tan Tock Seng Hospital, we conducted a retrospective cohort study involving 131 (58.7%) metformin users and 92 (41.3%) non-users. Dengue severity was categorized as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) in World Health Organization (WHO) 1997 criteria and severe dengue (SD) in WHO 2009 criteria. Multivariable Poisson regression with robust error variance was used to estimate risk ratio (RR). Compared with non-use, metformin use was associated with a decreased risk of developing severe dengue (adjusted risk ratio [aRR]=0.60, 95% confidence interval [CI]: 0.37–0.98, P=0.04). Additionally, there was an inverse dose-response relationship (aRR=0.69, 95% CI: 0.49–0.98, P=0.04) with dengue severity as classified by WHO 2009 criteria. Use of metformin, however, was not associated with dengue severity based on WHO 1997 criteria; and no dose-response relationship was noted. Our results suggest metformin use could attenuate disease severity in dengue-infected diabetes mellitus individuals.en
dc.format.extent9 p.en
dc.relation.ispartofseriesScientific Reportsen
dc.rights© 2018 The Author(s) (Nature Publishing Group). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit
dc.subjectDengue Severityen
dc.titleMetformin use and severe dengue in diabetic adultsen
dc.typeJournal Articleen
dc.contributor.schoolLee Kong Chian School of Medicine (LKCMedicine)en
dc.description.versionPublished versionen
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