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home/Knowledge Base/Other Internal Medicine Specialties

Considerations in the Management of Diabetes in the Pandemic Context

83 views 1 05/04/2020 Jane Wang

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.

Prevention:

  1. 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.
  2. 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.
  3. 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.
  4. 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).
  5. 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.

Treatment:

  1. Among hospitalized diabetic patients, an early switch to insulin is encouraged and increased need of insulin is expected compared to other acute conditions.
  2. Metformin and SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) should be discontinued for patients with severe symptoms from COVID-19.
  3. 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

Sources:

  1. 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
  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
Tags:diabetesclinical managementhyperglycemiahypoglycemic agentsinsulinback to work

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