Guidelines for the management of diabetes services and patients during the COVID‐19 pandemic

Abstract

The UK National Diabetes Inpatient COVID Response Group was formed at the end of March 2020 to support the provision of diabetes inpatient care during the COVID pandemic. It was formed in response to two emerging needs. First to ensure that basic diabetes services are secured and maintained at a time when there was a call for re-deployment to support the need for general medical expertise across secondary care services. The second was to provide simple safe diabetes guidelines for use by specialists and non-specialists treating inpatients with or suspected of COVID-19 infection. To date the group, comprising UK-based specialists in diabetes, pharmacy and psychology, have produced two sets of guidelines which will be continually revised as new evidence emerges. It is supported by Diabetes UK, the Association of British Clinical Diabetologists and NHS England.Diabet. Med. 00, 1-3 (2020)

Polycystic ovary syndrome (PCOS) and COVID-19: an overlooked female patient population at potentially higher risk during the COVID-19 pandemic

“…Giver the former use, it is not surprising that metformin has been considered among the drugs which could be repurposed against COVID-19, with potential antiviral effects through activation of the AMP-activated protein kinase (AMPK) pathway that would cause changes in the ACE-2 receptor and block the entry of SARS-CoV-2 into host cells [68]. However, metformin use can promote lactic acidosis in the context of marked dehydration and renal impairment in severe COVID-19; hence, women with PCOS under metformin treatment is advisable to consider stopping this agent when symptomatic with COVID-19, particularly if they become unstable, as also recommended for patients with diabetes [69][70][71].…”

Diabetes Patients of COVID-19 Infection Treated with Convalescent Plasma Transfusion in Wuhan, China

“…The increased morbidity and mortality of COVID-19 patients was particularly seen in older and those presenting comorbidities conditions, commonly cardiovascular diseases and diabetes [21]. Emerging data suggested that individual with diabetes comorbidity were at high risk for COVID-19 infection, and increased risk for complications including death [22,23]. To date,…”

SGLT-2 inhibitors as cardioprotective agents in COVID-19

“…An increased risk of euglycemic DKA occurs due to a reduced appetite leading to decreased carbohydrate consumption along with dehydration due to high fever or vomiting/diarrhoea and the osmotic diuretic effect of COVID-19 infection. 11 In addition, drug interactions are major concerns while prescribing SGLT2i. In view of these complications, health agencies had warned about safety concerns for SLGT2i and the risk of DKA in patients with both diabetes and COVID-19 infection.…”

“…In this setting, they have recommended to avoid SGLT2 inhibitors in all patients with risk factors for developing symptoms or serious complications of COVID-19. 11 The potential role of SGLT-2i is being explored in the form of Dapagliflozin in Respiratory Failure in Patients with COVID-19 (DARE-19, NCT04350593) trial 12 which is a phase III multinational RCT. This trial includes patients with mild-moderate COVID-19 infection and at least one of the following: type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, heart failure and stage 3-4 chronic kidney disease who shall be randomised to receive either dapagliflozin 10 mg once daily or placebo along with standard of care.…”