How should patients with diabetes manage their health during the COVID-19 pandemic?

This article made recommendations for patients with diabetes on how to manage their health during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This causes a chest infection that can potentially be fatal. Some people have a higher risk of developing a severe infection, including patients with diabetes. Doctors think this could be because these patients have weaker immune systems, have a higher risk of heart disease and many are older. It is important to prevent patients from getting COVID-19 and understand how to best treat patients who get infected.

Patients with diabetes should follow social distancing and hygiene recommendations from the World Health Organisation (WHO) and the government. Patients should also continue to take their medications as usual and especially for blood pressure, cholesterol, and heart disease. Patients taking angiotensin-converting enzyme (ACE) inhibitors for high blood pressure are recommended to continue taking the medication as usual. Similarly, patients taking statin medications for high cholesterol should continue taking medication as usual.

Patients who have received any type of transplant and those on immunosuppressant medication have a higher risk of developing severe COVID-19. Some patients with type 2 diabetes (T2D) also have fatty liver disease, which increases the risk of developing severe COVID-19. These patients should be closely monitored for different treatment options if they contract COVID-19.

Patients who are obese have a higher risk of developing a severe infection because extra body fat puts pressure on the lungs. Extra body fat also increases inflammation and inflammation increases the severity of COVID-19. Some patients with T2D are waiting on weight-loss surgery. This postponement may benefit patients as they are not exposed to hospital staff and patients who may have COVID-19. The surgery may temporarily weaken the lungs which would give patients a higher risk of developing a severe COVID-19 infection.

The SARS-CoV-2 virus causes an increase in blood glucose in many patients generally. The blood glucose of patients with a higher risk of diabetes (such as pre-diabetes) should be monitored.

Patients with diabetes who develop a COVID-19 infection should be closely monitored for a spike in high blood glucose (hyperglycemia). Severe hyperglycemia can lead to a complication called ketoacidosis, which can have serious consequences for patients. Patients with type 1 diabetes (T1D) have a higher risk of developing ketoacidosis if they develop COVID-19. 

Patients who develop a COVID-19 infection may need to stop taking metformin (Glucophage) or sodium-glucose transport protein 2 (SGLT2) inhibitor drugs, depending on clinicians’ advice. Other medications, including insulin, do not appear to affect patients. Patients should continue taking all medications prescribed to them unless otherwise directed by a doctor.

The authors concluded that patients with diabetes should try to prevent getting the COVID-19 infection where possible. Patients who get infected may need alternative treatment options and could have long-lasting complications after recovering.

COVID-19 is a relatively new infection and we still have a lot to learn. Advice may change as new information emerges.