Spotlight on treatment of COVID-19 in diabetes patients

Experts addressed minimizing cardiovascular risk, managing diabetes in the ICU, altering protocols, and monitoring glucose levels, while studies looked at insulin infusion and other interventions for patients with COVID-19.

Several recent articles offered guidance on treating COVID-19 in hospitalized patients with diabetes.

A study group of the European Association for the Study of Diabetes addressed issues of cardiovascular risk management in people with diabetes and COVID-19 in an article published by Diabetes Care on May 14. They noted that patients with diabetes have worse prognosis from COVID-19 and recommended that continuous glucose monitoring (CGM) be implemented whenever possible. ICU patients with hyperglycemia should be treated with IV insulin using exact dosing with a perfusion device, the paper said. The authors noted that although no evidence to date has suggested that medications commonly used by diabetes patients increase likelihood or severity of COVID-19, clinicians should keep an eye on emerging contraindications.

A letter published by Diabetes Care on May 27 offered additional guidance on diabetes management for ICU patients with COVID-19, including optimal insulin administration in patients receiving tube feeding or steroids and accurate glucose measurement in patients receiving vitamin C, acetaminophen, or albuterol. The authors also described their experience with two type 1 diabetes patients who were on closed-loop insulin infusion systems prior to admission.

A pragmatic approach to inpatient diabetes management during the pandemic was described in a paper published by the Journal of Clinical Endocrinology and Metabolism on June 4. It offered modified protocols for insulin administration, bedside glucose monitoring, and use of medications that may affect glycemic control, such as glucocorticoids. It noted that CGM systems “have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients.” The authors suggested that inpatient clinicians seek assistance from remote glucose management teams as needed. Physicians described how they converted a CGM system originally designed for diabetes self-management into a remote glucose monitoring tool for inpatients with COVID-19 in a letter published by Diabetes Care on May 14.

The benefits of insulin infusion for inpatients with COVID-19 were highlighted by a study of 59 patients published by Diabetes Care on May 19. Twenty-five patients had hyperglycemia at admission, and eight additional patients had diagnosed diabetes but normoglycemia. The study found that both hyperglycemia and diabetes were associated with more severe disease. Among those with hyperglycemia, treatment with an insulin infusion was associated with lower risk of severe disease. “Our data evidenced that optimal glucose control in the immediate postadmission period for almost 18 days was associated with a significant reduction of inflammatory cytokines and procoagulative status,” the authors said. “Thus, in the critical care setting, insulin infusion may be an effective method for achieving glycemic targets and reducing mortality in patients with Covid-19.”

Finally, another study suggested that COVID-19 patients with newly diagnosed diabetes might be most in need of inpatient interventions. In a study of 453 patients published by Diabetes, Obesity and Metabolism on May 29, the patients with newly diagnosed diabetes had higher risk of ICU admission and mortality than those with known diabetes, hyperglycemia but no diabetes, or normoglycemia. “Thus COVID-19 patients need to be under surveillance for blood glucose screening and COVID-19 patients with newly diagnosed diabetes should be paid more attention,” the authors said.