× Key messages Background Patients with diabetes and COVID-19 need close monitoring Conclusions Expert commentary
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Patients with diabetes and COVID-19 need close monitoring

  • DPP-4 has been implicated in the inflammatory response to SARS-CoV-2 infection, but there do not appear to be any major concerns about the use of DPP-4 inhibitors in patients with type 2 diabetes1.
  • Among all drugs used to treat diabetes, only insulin appears may be weakly associated with adverse outcomes in patients with COVID-19; however, this very likely reflects a more advanced stage of diabetes with more comorbidities2.
  • There appears to be an association with body mass index (BMI) and tracheal intubation and/or death within 7 days in patients with diabetes and hospitalized for COVID-192.
  • General recommendations include physical distancing, personal hygiene, hand washing, and wearing masks.
  • Other recommendations include the following:
    • Prepare a list of all medications, written and on phone.
    • Consider supplies of medication, test strips, and continuous glucose monitoring.
    • Do not neglect exercise, diet, blood glucose control, and blood pressure control.
    • Whenever possible, use telemedicine and devices to communicate with healthcare providers.
    • Maintain appropriate level of hydration, exercise, glucose, and ketone monitoring.
  • When in the hospital, consider the following:
    • State of hydration, food, oral, enteral, intravenous nutrition
    • Renal and hepatic function
    • Possibility of insulin deficiency and ketosis.
    • Diagnostic procedures/contrast dye.
    • Steroids, cytokines, and immunomodulators.
  • The following consideration are possible for glucose-lowering agents:
    • Metformin: gastrointestinal tract adverse events, estimated glomerular filtration Rate (eGFR), lactic acidosis.
    • Sulfonylureas: prudent to discontinue.
    • SGLT2 inhibitors: consider discontinuation.
    • DPP-4 inhibitors: eGFR, modest glucose reduction±inflammation.
    • Thiazolidinediones: volume status, CHF, prudent to discontinue.
    • GLP-1 receptor agonists: eGFR±inflammation, prudent to discontinue exenatide if eGFR decreasing.
  • There is insufficient evidence to define optimal glycemic ranges for hospitalized people with severe critical illness, although avoidance of hypoglycemia is essential as well as safe avoidance of hyperglycemia.