Prevention and management of COVID-19 among patients with diabetes: an appraisal of the literature

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has emerged as one of the greatest challenges faced by humankind in the recent past. People with diabetes and related comorbidities are at increased risk of its complications and of COVID-19-related death. Older age, multi-morbidity, hyperglycaemia, cardiac injury and severe inflammatory response are predictors of poor outcome. The complex interplay between COVID-19, diabetes and the effects of related therapies is being explored. Most patients experience a mild illness with COVID-19, while people with diabetes are at increased risk of severe disease. Optimising glycaemic control and adopting measures to prevent disease spread are critical aspects. The management of mild disease is supportive, while very many immunomodulatory and antiviral therapies are being investigated for the treatment of severe disease. Several of these agents have specific considerations for use in people with diabetes. Since mass population lockdowns are considered a key step in controlling disease spread, it follows that, in addition to the direct vulnerability to severe COVID-19, people with diabetes can be affected by limited access to healthcare, insulin, other medications and blood glucose monitoring equipment. Measures to prevent disease spread at the individual and community level are the key to mitigating the rapidly escalating pandemic, while agents for chemoprophylaxis and vaccines are being explored. People with diabetes should be recognised as a vulnerable group for complicated disease and are at risk during times of disturbed social systems. Strategies are needed to safeguard the health of patients with diabetes during the pandemic. This review summarises the current knowledge and perceived challenges for prevention and management of COVID-19 in people with diabetes.

Endocrine Conditions and COVID-19

“…From a clinical practice standpoint patient counseling should include discussing glycemic goals and sick day insulin dosing regimens, as well as adequate hydration and maintaining access to food (including nonperishable items, glucose and electrolyte tablets). Furthermore, adoption and continuation of a healthy diet and recommended 150 minutes of weekly exercise such as indoor walking and other physical distancing compatible exercises should be encouraged [56]. Recommended vaccinations for influenza, pneumococcal and other infections should be emphasized (based on CDC or equivalent local authority guidelines).…”

“…In these patients less aggressive insulin regimens with the aim of minimizing glycosuria, dehydration, and electrolyte disturbances may be more appropriate, however clinical judgment combined with continuing assessment of clinical status that includes changes in the trajectory of glucose measures, illness severity, nutritional status, or concomitant medications that might affect glucose levels, should be incorporated into medical decision making. Furthermore, it is reasonable to discontinue sodium-glucose co-transporter-2 inhibitors (SGLT-2i) that have been associated with intravascular volume depletion and increased risk of euglycemic ketosis [56]. Discontinuation of sulfonylureas is also advisable, particularly in critical patients, where drug renal clearance may be compromised [56].…”

“…Furthermore, it is reasonable to discontinue sodium-glucose co-transporter-2 inhibitors (SGLT-2i) that have been associated with intravascular volume depletion and increased risk of euglycemic ketosis [56]. Discontinuation of sulfonylureas is also advisable, particularly in critical patients, where drug renal clearance may be compromised [56]. Chloroquine and hydroxochloroquine, which are under investigation for efficacy in the treatment of COVID-19, may cause hypoglycemia [65,66].…”

Clinical Characteristics of 538 Novel Coronavirus Disease Patients with Chronic Underlying Diseases in Wuhan, China: A retrospective Study

“…Another study suggested that COVID-19 patients using ACEIs and ARBs during hospitalization will not increase the risk of death [18]. As for diabetes, though, people with diabetes might be at increased risk of severe disease, no existing conclusive evidence supports the discontinuation of ACEIs, ARBs, or thiazolidinediones in people with diabetes for precaution of COVID-19 [19,20]. Katulanda et al proposed that, in addition to the direct vulnerability to severe COVID-19, people with diabetes should be recognized as a vulnerable group for complicated disease and are at risk since the potential limited access to insulin, blood glucose monitoring equipment, and other healthcare which would be impacted by the COVID-19 [19].…”

“…As for diabetes, though, people with diabetes might be at increased risk of severe disease, no existing conclusive evidence supports the discontinuation of ACEIs, ARBs, or thiazolidinediones in people with diabetes for precaution of COVID-19 [19,20]. Katulanda et al proposed that, in addition to the direct vulnerability to severe COVID-19, people with diabetes should be recognized as a vulnerable group for complicated disease and are at risk since the potential limited access to insulin, blood glucose monitoring equipment, and other healthcare which would be impacted by the COVID-19 [19]. Therefore, we believe that patients with hypertension and diabetes should pay more attention to the prevention against SARS-CoV-2, and su cient medical support to these vulnerable people is necessary.…”