Editorial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2022; 13(10): 802-808
Published online Oct 15, 2022. doi: 10.4239/wjd.v13.i10.802
Considerations for management of patients with diabetes mellitus and acute COVID-19
Efterpi Mougakou, Maria Kyziroglou, Alexandra Tsankof, Evangelos Cholongitas, Konstantinos Tziomalos
Efterpi Mougakou, Evangelos Cholongitas, First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece
Maria Kyziroglou, Alexandra Tsankof, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
Author contributions: Mougakou E, Kyziroglou M and Tsankof A drafted the manuscript; Cholongitas E and Tziomalos K critically revised the draft.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantinos Tziomalos, MD, MSc, PhD, Associate Professor, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, Thessaloniki 54636, Greece. ktziomalos@yahoo.com
Received: March 30, 2022
Peer-review started: March 30, 2022
First decision: May 11, 2022
Revised: May 23, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: October 15, 2022
Abstract

Diabetes mellitus (DM) is an independent risk factor for admission to intensive care unit and death in patients with coronavirus disease 2019 (COVID-19). On the other hand, medications used in the management of COVID-19 are potentially associated with increases in blood glucose levels and a higher incidence of infections. Accordingly, care of patients with DM and acute COVID-19 requires careful consideration of both diseases. Hyperglycemia and hypoglycemia are associated with adverse outcomes and therefore frequent measurement of blood glucose levels and a basal-bolus insulin regimen are required in most patients. Regarding the management of COVID-19, dexamethasone increases blood glucose levels and might also increase the risk for infections. On the other hand, limited data suggest that antiviral and immunomodulatory agents used in COVID-19 are not strongly associated with higher incidence of infections in this population. As knowledge evolves in this field, optimization of the management of both DM and COVID-19 will hopefully improve the outcome of these patients.

Keywords: Diabetes mellitus, COVID-19, Insulin, Antidiabetic agents, Dexamethasone, Tocilizumab, Remdesivir

Core Tip: Diabetes mellitus is a frequent comorbidity in patients hospitalized with coronavirus disease 2019 and is associated with adverse outcomes. Strict glycemic control using insulin is necessary in most of these patients. Dexamethasone, antiviral agents and immunomodulation are also frequently administered and require vigilance and careful monitoring for adverse effects, particularly infections.