Diabetes and COVID-19: Clinical Considerations and Recommendations

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In the COVID-19 pandemic, there are specific considerations that should be made for patients with diabetes, who are at greater risk for severe infection.

Patients with diabetes are at increased risk for various infections, and in the pandemic of coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), several measures to prevent infection and manage patients with diabetes and COVID-19 may prove to be important, according to a review published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews.

The COVID-19 outbreak was declared a pandemic by the World Health Organization, as the disease, primarily spread through large respiratory droplets, is affecting many countries worldwide. It is believed that patients with diabetes, who are at increased risk for infections such as influenza and pneumonia, may also develop severe disease when infected with SARS-CoV-2.

Limited data exist on the outcomes of COVID-19 in patients with diabetes. In one study, diabetes was present in >40% of fatalities caused by COVID-19, and another small series reported increased mortality in people with diabetes (2.3% overall vs 7.3% in those with diabetes). However, in other research, diabetes was not a risk factor for severe disease.

General measures to prevent COVID-19 include thorough hand washing with soap and water and/or alcohol-based hand rubs, practice of proper respiratory hygiene, minimizing contact with affected individuals, and avoiding nonessential travel to affected areas.

There are several specific measures recommended to prevent COVID-19 in patients with diabetes, including maintaining good glycemic control, as this can reduce the risk for severe infection and bacterial pneumonia; stabilizing cardiac and renal status; maintaining adequate nutrition and physical exercise; and completing influenza and pneumonia vaccinations.

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There are also several suggested measures for patients with diabetes and COVID-19 infection. These include notifying the appropriate health authority when there is a clinical suspicion for COVID-19, isolating for 14 days or until symptoms resolve, and maintaining hydration and symptomatic treatment. Patients with type 1 diabetes should measure blood glucose and urinary ketones frequently in case of fever with hyperglycemia. Antihyperglycemic treatment should be adjusted to avoid hypoglycemia and volume depletion and patients should follow sick day guidelines. In severe cases when patients are hospitalized, it is recommended to frequently monitor blood glucose and cease the use of oral agents, especially metformin and sodium-glucose cotransporter-2 inhibitors, as insulin is the preferred treatment modality in this scenario.

With regard to the current state of COVID-19 treatment and future directions in the pandemic, there are several potential unproven therapies for COVID-19, including anecdotal use of various antiviral drugs, zinc nanoparticles, and vitamin C supplementation, but more studies are required. In addition, there are ongoing efforts to develop a vaccine, which will be essential to contain this pandemic.

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Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr. 2020;14(3):211–212.