Issues for the management of people with diabetes and COVID-19 in ICU

Abstract

In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.

Hyperglycemia and COVID-19: What was known and what is really new?

“…In conclusion, the effect of acute hyperglycemia during COVID-19 is not so much surprising and it should be treated according to the already existing guidelines [16][17][18].…”

Risk factors for hospital admission among COVID-19 patients with diabetes

“…26 However, the studies available at present indicated that even optimal glycemic control, avoidance of acute hyperglycemia, hypoglycemia, and glycemic variability could cause a significant improvement in the outcomes of the COVID-19 patients with diabetes. 27 In a retrospective study carried out in the USA on 451 patients with COVID-19 and diabetes or hyperglycemia, it appeared that patients with uncontrolled hyperglycemia endured longer hospital stays and experienced higher mortality rate in the hospital compared with those whose blood sugar levels were under control. 28 Another study revealed that uncontrolled diabetes with HbA1c >9% corresponded to an approximately 60% greater risk of pneumonia-related hospitalization in the course of the bacterial infection.…”

“Diabetes as a case study of chronic disease management”: Eight years later. The opportunity learned from the COVID-19 pandemic

“…Several recommendations have been published on how to manage several specific aspects when COVID-19 is present in people with diabetes [2] , [3] , [4] or on how to manage the diabetes therapy during the pandemic [4] , [5] . However, it is clear that any recommendation to be followed needs an interaction between the person with diabetes and the health care professionals, which has been the major challenge in the period of lockdown and social distance [6] .…”