Diabetes is an important risk factor for poorer outcomes in COVID-19. Mechanistic hypotheses include the effect of acute and chronic hyperglycemia on angiotensin-converting-enzyme-2 receptor, impaired immune response and confounding population characteristics such as age and cardiovascular comorbidities.
- Patients at risk of metabolic disease who have contracted the infection should be monitored to prevent new onset of diabetes because of the direct pancreatic damage by the virus.
- Hypokalemia should be monitored in hospitalized diabetic patients since it is a common feature of COVID-19 and could be exacerbated by the introduction or increased dosage of insulin.
- The importance of a good glycemic control should be re-emphasized to patients (preferentially through telemedicine). Type 1 diabetes patients should closely monitor signs and symptoms of diabetic ketoacidosis.
- For patients using continuous glucose measurement (CGM) and flash glucose measurement (FGM), aim for time in range of 3.9-10 mmol/L of > 70% (>50% in frail people) and time in hypoglycemia (< 3.9 mmol/L) of < 4% (<1% in frail people).
- Health-care professionals with diabetes should avoid working in the front line during the pandemic. If reattribution is impossible, they should use high grade protection while working.
- Among hospitalized diabetic patients, an early switch to insulin is encouraged and increased need of insulin is expected compared to other acute conditions.
- Metformin and SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) should be discontinued for patients with severe symptoms from COVID-19.
- If chloroquine is used, a dose adjustment in the diabetes therapy might be needed to prevent hypoglycemia because of the potential improvement in glucose control secondary to the introduction of chloroquine.
These data come from 2 publications. The first publication is a consensus document by international experts.1 The second publication is a scoping review about COVID-19 and its implications in diabetes.2
- Bornstein, S. R., Rubino, F., Khunti, K., Mingrone, G., Hopkins, D., Birkenfeld, A. L., Boehm, B., Amiel, S., Holt, R. I., Skyler, J. S., DeVries, J. H., Renard, E., Eckel, R. H., Zimmet, P., Alberti, K. G., Vidal, J., Geloneze, B., Chan, J. C., Ji, L., & Ludwig, B. (April 23rd 2020). Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. https://doi.org/10.1016/S2213-8587(20)30152-2
- Hussain, A., Bhowmik, B., & do Vale Moreira, N. C. (April 9th 2020). COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. https://doi.org/10.1016/j.diabres.2020.108142