Introduction
The coronavirus disease (COVID‐19) pandemic has continued to have a devastating impact on health worldwide. There has been a rapid evolution of evidence, establishing an increased risk of morbidity and mortality associated with diabetes and concurrent COVID‐19. The objective of this review is to explore the current evidence for inpatient assessment and management of diabetes during the COVID‐19 pandemic and highlight areas requiring further exploration.
Methods
A literature search of databases was conducted to November 2020 using variations on keywords SARS‐CoV‐2, COVID‐19, SARS, MERS and diabetes. Information relating to the impact of diabetes on severity of COVID‐19 infection, the impact of COVID‐19 infection on diabetes management and diabetes‐related complications was integrated to create a narrative review.
Discussion
People with diabetes and COVID‐19 are at an increased risk of morbidity and mortality. It is important that people with both known and previously unrecognised diabetes and COVID‐19 be promptly identified and assessed during acute illness, with close monitoring for clinical deterioration or complications. People with diabetes may require titration or alteration of their glycaemic management due to the potential for worse outcomes with hyperglycaemia and COVID‐19 infection. Comprehensive discharge planning is vital to optimise ongoing glycaemic management.
Conclusion
Further understanding of the risk of adverse outcomes and optimisation of glycaemic management for people with diabetes during COVID‐19 is required to improve outcomes. Increased glucose and ketone monitoring, substitution of insulin for some oral anti‐hyperglycaemic medications and careful monitoring for complications of diabetes such as diabetic ketoacidosis should be considered.
However, Brewster and colleagues found a left-sided excess of melanoma exists even in countries where vehicles are driven from the right side, such as the United Kingdom and Australia. As this is inconsistent with driving-related exposure, it was theorised that this left-sided predominance may be due to anatomical or embryological asymmetry, or some unknown other difference in ultraviolet exposure. 6,7 Our study found that there was no significant laterality in the distribution of malignant and premalignant skin lesions, regardless of age, gender, site of lesion or histopathological diagnosis.Driving-related ultraviolet exposure appears to no longer be a major factor in the distribution of melanoma and nonmelanoma skin cancer. This may be due to the increasing use of air conditioning in vehicles, or to attribution error in previous research. It is possible that a larger study, including clinical components such as field UV damage and skin type and detailed demographic data such as occupation and patterns of sun exposure, may be able to further characterise any small difference in laterality of these skin lesions.
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