Management of diabetes in elderly patients during the COVID-19 pandemic: current and future perspectives

ABSTRACT

Introduction: The COVID-19 pandemic has affected the entire population with the most deleterious effects in elders. Elders, especially those with diabetes, are at the highest risk of COVID-19 related adverse outcomes and mortality. This is usually linked to the comorbidities that accumulate with age, diabetes-related chronic inflammation, and the pandemic’s psychosocial effects.

Areas covered: We present some approaches to manage these complicated elderly patients with diabetes during the COVID-19 pandemic. In the inpatient setting, we suggest similar (pre-pandemic) glycemic targets and emphasize the importance of using IV insulin and possible use of continuous glucose monitoring to reduce exposure and PPE utilization. Outside the hospital, we recommend optimal glycemic control within the limits imposed by considerations of safety. We also describe the advantages and challenges of using various technological platforms in clinical care.

Expert opinion: The COVID-19 pandemic has lifted the veil off serious deficiencies in the infrastructures for care at both the individual level and the population level and also highlighted some of the strengths, all of which affect individuals with diabetes and COVID-19. We anticipate that things will not return to ‘normal’ after the COVID-19 pandemic has run its course, but rather they will be superseded by ‘New Normal.’

KEYWORDS:

• COVID-19
• diabetes
• elderly
• hyperglycemia
• telemedicine

Article highlights

• Elderly patients with diabetes are at the highest risk of adverse outcomes and mortality caused by COVID-19. These are related to the multiple comorbidities, frailty, cognitive dysfunction, chronic inflammation due to diabetes, disease burden, and psychosocial effects from COVID-19 itself.

• Emphasize the importance of optimal glycemic control in patients with diabetes within the limits imposed by considerations of safety.

• Given the higher mortality rate in hospitalized elderly patients with diabetes, we suggest the use of close glucose monitoring possibly by using CGM and administration of IV insulin to attain appropriate glycemic targets.

• Use preventive measures and emphasize their use to patients, caregivers and the general public; social distancing, mask wearing, and hand washing strategies will prevent infection and its spread to older adults with diabetes.

• Reduce the disruption of medical management by optimizing and simplifying medication regimens where possible and do not prematurely discontinue the established therapy.

• Utilization of telemedicine, remote glucose monitoring systems and mail order drug delivery system to facilitate maximal social distancing.

• Recognize that the science is evolving rapidly, and recommendations made today may require revision tomorrow.

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.

Additional information

Funding

This paper was not funded.