Management of diabetes in patients with coronavirus disease 2019: A practical approach

Coronavirus disease 2019 (COVID-19) has emerged as a rapidly transmissible communicable disease around the globe. Diabetes is reported as a common morbidity in patients with COVID-19, has been associated with worse clinical outcomes, and may lead to higher mortality. Because the disease has variable presentations varying from mild respiratory symptoms to pneumonia and respiratory failure, proper care of patients with diabetes in this context should cover both outpatient and inpatient sectors. Outpatient management in acutely ill patients includes frequent home glucose monitoring; holding certain medications including metformin, sodium glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists that may cause unwanted side effects such as dehydration and resulting acute kidney injury; continuation and adjustment of insulin therapy; and patient education on indications to seek medical assistance. Inpatient glucose management of patients admitted with COVID-19 involves holding noninsulin medications, monitoring blood glucose, and starting insulin if glucose levels are not in target. Intravenous insulin is recommended for critically ill patients with uncontrolled glucose. Universal measures should include assurance of continuity of care, adherence to therapy, and self-management education using connected health models and telemedicine. Patients with diabetes are considered a vulnerable group during periods of epidemics, and clear recommendations and pathways are essential to assure patients' safety.