COVID-19 & ADULT DIABETICS
COVID-19 & ADULT DIABETICS
Ptns with type 2 DM are more vulnerable to develop serious complications, more ICU admission, longer hospital stay, and death from coronavirus infection 2019 (COVID-19). Despite there’re sparse data, ptns with type 1 DM also may develop higher MR from COVID-19 as compared to general population. COVID-19 diease appears to induce and unmask severe complications of DM e.g. diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and intense insulin resistance. Sick-day control may focus on prevention of hypoglycemia, severe hyperglycemia, & DKA. For ptns with a known PH of DM, or in ptns with metabolic acidosis on initial admission lab-evaluation, we should evaluate the serum ketones levels.
There’re no strict data to provide the precise glycemic target for ptns with COVID-19. Generally, the goal is usually the same as in other hospitalized ptns (e.g., avoid intense hyperglycemia, volume depletion, & electrolyte imbalance; avoid hypoglycemia; keep adequate nutrition). The blood glucose target of 140-180 mg/dL (7.8-10 mmol/L) is accepted for most hospitalized ptns. Many oral drugs hv special CI that may be observed in hospitalized ptns. So, home DM medications are usually withdrawn. Particularly, sodium-glucose co-transporter 2 (SGLT2) inhibitors must be stopped owing to the higher risk of dehydration & volume depletion. Metformin is C.I. in condition in which kidney function and/or hemodynamic states is either compromised or threatened, due to a higher risk of lactic acidosis, so, they must be withdrawn at least temporarily until the clinical status is clearer. Other diabetic medications may not be appropriate due to untoward side-effects.
Insulin is the preferred therapy for hyperglycemia in ptns hospitalized with moderately severe COVID-19 disease. For ptns with type 2 DM, the need for insulin therapy may be transient. Ptns with type 1 DM are in absolute need for insulin therapy at ALL the time, whether or not they’re eating, to abort ketosis development. SC insulin protocol are usually applied with increasing frequency to treat mild/moderate DKA during the COVID-19 pandemic episodes if I.V. insulin is not practical due to the need to limit frequencies of contact betwen staff and the ptns. In such case, dosage & monitoring are being performed every 2-4 hs. S.C. insulin protocol is not used in ptns with the following conditions:
1) Advanced DKA;
2) Severe cardiac disease,
3) Renal, or hepatic co-morbidity; or with
4) Pregnant ladies.
Intense insulin resistance has been reported in critically ill ptns with COVID-19 disease. Severity of insulin resistance, however, may be ameliorated rapidly with COVID-19 subsided disease, that may lead to a rapid decline in insulin requirements.
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054.
- Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev 2020; :e3319.
- Bode B, Garrett V, Messler J, et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol 2020; 14:813.
- Targher G, Mantovani A, Wang XB, et al. Patients with diabetes are at higher risk for severe illness from COVID-19. Diabetes Metab 2020; 46:335.
- https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf (Accessed on July 02, 2020).
- https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf (Accessed on July 02, 2020).
- Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020; 323:1239.