Takeaway
- Worse COVID-19 outcomes with diabetes likely relate to cardiovascular (CV) comorbidities.
- COVID-19-related cardio-renal-pulmonary damage affects CV risk management for people with diabetes.
Study design
- Expert opinion of Diabetes and Cardiovascular Disease Study Group of the European Association for the Study of Diabetes.
- Funding: None disclosed.
Suggested strategies
- On admission, evaluate for >1 risk factors:
- Hypertension, diabetes, obesity, smoking.
- If yes, assess for:
- Lung disease, coronary artery disease, myocardial infarction, heart failure, arrhythmias, transient ischemic attack/stroke, peripheral arterial disease, chronic kidney disease.
- Assess biomarkers:
- High C-reactive protein, elevated creatinine/estimated glomerular filtration rate /minute/1.73 m2, HbA1c >7.5% (58 mmol/mol), hyperglycemia, abnormal blood gas, elevated hs-troponin, high natriuretic peptide, elevated D-dimer, ferritin, increased creatinine kinase.
- In intensive care:
- Stop oral glucose-lowering agents and subcutaneous insulin.
- Switch to intravenous insulin for glucose control (perfusor).
- Use continuous glucose monitoring (CGM) if available.
- Abstain from steroids.
- Continue renin-angiotensin system (RAS) inhibitors and statins.
- Use appropriate anticoagulation.
- On the general ward:
- Consider contraindications to metformin, sulfonylureas, sodium-glucose transporter 2 inhibitors, pioglitazone, a-glucosidase inhibitors.
- Preferentially consider dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, subcutaneous insulin for glucose control.
- Use CGM if available.
- Consider glycemic effects of experimental anti-COVID-19 drugs (e.g., hydroxychloroquine).
- Abstain from steroids.
- Continue RAS inhibitors/statins, appropriate anticoagulation.
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