Patients with diabetes represent 20 to 50 per cent of COVID-19 patients, and they are at increased risk of severe complications with this disease. To address this vulnerability, an international panel of diabetes and endocrinology experts has assembled guidance for the management of diabetes during the COVID-19 pandemic.
In summary, those currently uninfected with SARS-CoV-2 should primarily prevent COVID-19 by; intensifying their metabolic, blood pressure, and blood lipids control, reducing their exposure by consulting with their medical professionals through telemedicine, in addition to hand-washing and social distancing.
Those at-risk for metabolic diseases who have COVID-19 should be monitored for new-onset diabetes as the virus may trigger it. Those with diabetes and COVID-19 require continuous and reliable glycaemic control in addition to electrolytes, pH, and blood ketone monitoring. Severe cases of COVID-19 should be managed with early intravenous insulin therapy.
Since metformin can be associated with lactic acidosis and SGLT-2 inhibitors can be associated with diabetic ketoacidosis, they should be discontinued in patients with severe COVID-19. However, discontinuation is not recommended prophylactically in patients without COVID-19 infection.
Although these recommendations are based on the expert opinion, and clinical trial results are pending, they may be useful to clinicians until more data becomes available.