SAT-579 Potential Glucose-Lowering Properties of Paxlovid® in Type 2 Diabetes Patients

Abstract Disclosure: S. Dickerman: None. F.A. Al-Khayer: None. Introduction: Nirmatrelvir-ritonavir co-packaged as Paxlovid® are drugs designed to combat the negative consequences of SARS-CoV-2 infection such as hospitalization. This drug has been shown to alter blood glucose levels in patients with diabetes by interfering with common antidiabetic agents such as metformin and insulin to raise blood glucose levels. Clinical Case: This is the case of a 58-year-old female patient with a five-year history of poorly controlled Type 2 diabetes mellitus. The patient initially presented to the endocrinology office with hyperglycemia to the 320s mg/dL and a hemoglobin A1C of 10%. The patient was started on several medications including insulin and eventually tirzepatide. Four years after treatment, the average blood sugar was 111 mg/dL and the A1c was 6.0%. This patient experienced two SARS-CoV-2 infections, in September 2022 and January 2023 and was treated with Paxlovid® with excellent results. Following one day of Paxlovid® treatment in the primary infection, her blood sugar dropped to 89 mg/dL and stayed consistently steady for 4 days ranging from 74-97. The patient stopped taking insulin and tirzepatide during this time without elevation in her blood sugar. A few days after finishing her therapy with Paxlovid, the patient had to resume tirzepatide and insulin but maintained an average blood glucose of 95 mg/dL. At this point, the patient had an A1c of 5.3%. During secondary SARS-CoV-2 infection in January 2023, the patient’s insulin requirements once again decreased while taking Paxlovid®. One-month post-infection and resuming insulin, the patient maintained an average blood sugar of 92 mg/dL and an A1c of 4.8%. Conclusion: It is widely understood that bacterial and viral infectious agents may transiently raise blood glucose levels during the active infection phase. Additionally, those with Type 2 diabetes are markedly more likely to develop severe viral infections because hyperglycemia may impair immune function. Prior studies have indicated that SARS-CoV-2 infection and Paxlovid® treatment may raise blood glucose levels, not lower them. This case deviates from these findings. Although the mechanism(s) of action underlying this case are not understood and have not been widely observed in previous cases, it is important to acknowledge that Paxlovid® treatment may lead to lower blood glucose levels. Patients with hyperglycemia may experience a positive impact on their blood glucose levels but patients prone to hypoglycemia may need to exhibit increased caution when utilizing this drug. Regardless, further research and additional patient case observations are necessary to make any conclusions about the side effects observed in this patient after taking Paxlovid®. However, this case may serve as the basis for future research into alternative applications of Paxlovid®. Presentation: Saturday, July 12, 2025