Individualizing Inpatient Diabetes Management During the Coronavirus Disease 2019 Pandemic

Abstract

Diabetes is associated with poor clinical outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). During this pandemic, many hospitals have already become overwhelmed around the world and are rapidly entering crisis mode. While there are global efforts to boost personal protective equipment (PPE) production, many centers are improvising care strategies, including the implementation of technology to prevent healthcare workers' exposures and reduce the waste of invaluable PPE. Not optimizing glycemic control due to clinical inertia driven by fear or lack of supplies may lead to poor outcomes in patients with diabetes and COVID-19. Individualized care strategies, novel therapeutic regimens, and the use of diabetes technology may reduce these barriers. However, systematic evaluation of these changes in care is necessary to evaluate both patient- and community-centered outcomes.

Keywords: COVID-19; diabetes; hospitalized; hyperglycemia; inpatient.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: FJP and GEU are partially supported by National Institutes of Health grants (1K23GM128221-01A1 [FJP], UL1TR002378, and 1P30DK111024-01 [GEU]). FJP has received research support from Merck and Dexcom, and consulting fees from Boehringer Ingelheim, Sanofi, Lilly, and AstraZeneca. GEU has received unrestricted research support for inpatient studies (to Emory University) from Dexcom, Novo Nordisk, and Sanofi.

Figures

Figure 1.

Individualized antihyperglycemic therapy in in non-critically ill patients with type 2 diabetes during the Covid-19 pandemic. AC, before meals; BG, blood glucose; CGM continuous glucose monitoring; Covid-19, coronavirus disease 2019; DPP-4, dipeptidyl peptidase-4; GLP1, glucagon-like peptide 1; PPE, personal protective equipment; PUI, persons under investigation; TDD, total daily dose. *Consider Saxagliptin if no renal failure or congestive heart failure. **Antidiabetic agents: oral agents and/or GLP1-RA. ***In patients with hypoglycemia risk (frail: elderly, renal failure) reduce starting dose to 0.15 U/kg/day (basal alone) or TDD 0.3 U/kg/day (basal bolus). ¶Monitor glucose levels once a day if stable glycemic control is achieved for more than two days, intensify if change in clinical status. No prospective studies have determined the efficacy of other oral antidiabetic drugs in the hospital setting. Metformin is commonly used in the hospital (renally dosed metformin is associated with low risk of lactic acidosis). The use of premixed insulin regimens is discouraged in the hospital. Intravenous insulin therapy is the therapy of choice in critically ill patients. Adapted from Pasquel et al. with permission from Springer Nature (Copyright 2019).