Pharmacotherapeutic considerations for the management of diabetes mellitus among hospitalized COVID-19 patients

ABSTRACT

Introduction

Diabetes mellitus is one of the most prevalent comorbidities identified in patients with coronavirus disease 2019 (COVID-19). This article aims to discuss the pharmacotherapeutic considerations for the management of diabetes in hospitalized patients with COVID-19.

Areas covered

We discussed various aspects of pharmacotherapeutic management in hospitalized patients with COVID-19: (i) susceptibility and severity of COVID-19 among individuals with diabetes, (ii) glycemic goals for hospitalized patients with COVID-19 and concurrent diabetes, (iii) pharmacological treatment considerations for hospitalized patients with COVID-19 and concurrent diabetes.

Expert opinion

The glycemic goals in patients with COVID-19 and concurrent type 1 (T1DM) or type 2 diabetes (T2DM) are to avoid disruption of stable metabolic state, maintain optimal glycemic control, and prevent adverse glycemic events. Patients with T1DM require insulin therapy at all times to prevent ketosis. The management strategies for patients with T2DM include temporary discontinuation of certain oral antidiabetic agents and consideration for insulin therapy. Patients with T2DM who are relatively stable and able to eat regularly may continue with oral antidiabetic agents if glycemic control is satisfactory. Hyperglycemia may develop in patients with systemic corticosteroid treatment and should be managed upon accordingly.

KEYWORDS:

• Antidiabetic
• coronavirus 2019 (COVID-19)
• diabetes
• type 1 diabetes
• types 2 diabetes
• therapeutics

Article highlights

• Up to 12-18% of patients with COVID-19 had concurrent diabetes and the presence of diabetes is one of the risk factors for developing severe course of COVID-19.

• Therapeutic goals in patients with COVID-19 and concurrent diabetes requiring hospitalization include minimisation of disturbances to the metabolic state, prevention of adverse glycaemic events including hypoglycaemia, and diabetic ketoacidosis/hyperosmotic hyperglycaemic state, as well as maintenance of a stable glycaemic balance.

• Type 1 diabetes patients require insulin therapy during hospitalization for COVID-19. Moreover, insulin therapy is preferred for the management of hyperglycaemia in hospitalised patients with COVID-19 and concurrent type 2 diabetes.

• Upon admission and during hospitalisation for COVID-19, type 2 diabetes patients receiving oral antidiabetic agents require a careful assessment of the need to continue/discontinue of these agents based on their clinical course.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.