Practical recommendations for the management of diabetes in patients with COVID-19

Stefan R Bornstein¹, Francesco Rubino², Kamlesh Khunti³, Geltrude Mingrone⁴, David Hopkins⁵, Andreas L Birkenfeld⁶, Bernhard Boehm⁷, Stephanie Amiel⁸, Richard Ig Holt⁹, Jay S Skyler¹⁰, J Hans DeVries¹¹, Eric Renard¹², Robert H Eckel¹³, Paul Zimmet¹⁴, Kurt George Alberti¹⁵, Josep Vidal¹⁶, Bruno Geloneze¹⁷, Juliana C Chan¹⁸, Linong Ji¹⁹, Barbara Ludwig²⁰

Affiliations

¹ Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany. Electronic address: Stefan.Bornstein@uniklinikum-dresden.de.
² Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Bariatric and Metabolic Surgery, King's College Hospital, London, UK.
³ Diabetes Research Centre, University of Leicester, Leicester, UK.
⁴ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK.
⁶ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany; Department of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany.
⁷ Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.
⁸ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK.
⁹ Human Development and Health, Faculty of Medicine, University of Southampton, UK.
¹⁰ Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
¹¹ Department of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Profil Institute for Metabolic Research, Neuss, Germany.
¹² Montpellier University Hospital and Institute of Functional Genomics, Centre national de la recherche scientifique, INSERM, University of Montpellier, Montpellier, France.
¹³ Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
¹⁴ Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
¹⁵ Division of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK.
¹⁶ Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain.
¹⁷ Obesity and Comorbities Research Center, Laboratory of Investigation in Metabolism and Diabetes/Gastrocentro, Universidade de Campinas, Campinas, São Paulo, Brazil.
¹⁸ Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
¹⁹ Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China.
²⁰ Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Deutsche Forschungsgemeinschaft-Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.

PMID: 32334646
PMCID: PMC7180013
DOI: 10.1016/S2213-8587(20)30152-2

Review

Practical recommendations for the management of diabetes in patients with COVID-19

Stefan R Bornstein et al. Lancet Diabetes Endocrinol. 2020 Jun.

. 2020 Jun;8(6):546-550.

doi: 10.1016/S2213-8587(20)30152-2. Epub 2020 Apr 23.

Authors

Affiliations

¹ Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany. Electronic address: Stefan.Bornstein@uniklinikum-dresden.de.
² Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Bariatric and Metabolic Surgery, King's College Hospital, London, UK.
³ Diabetes Research Centre, University of Leicester, Leicester, UK.
⁴ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK.
⁶ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany; Department of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany.
⁷ Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.
⁸ Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK.
⁹ Human Development and Health, Faculty of Medicine, University of Southampton, UK.
¹⁰ Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
¹¹ Department of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Profil Institute for Metabolic Research, Neuss, Germany.
¹² Montpellier University Hospital and Institute of Functional Genomics, Centre national de la recherche scientifique, INSERM, University of Montpellier, Montpellier, France.
¹³ Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
¹⁴ Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
¹⁵ Division of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK.
¹⁶ Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain.
¹⁷ Obesity and Comorbities Research Center, Laboratory of Investigation in Metabolism and Diabetes/Gastrocentro, Universidade de Campinas, Campinas, São Paulo, Brazil.
¹⁸ Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
¹⁹ Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China.
²⁰ Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Deutsche Forschungsgemeinschaft-Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.

PMID: 32334646
PMCID: PMC7180013
DOI: 10.1016/S2213-8587(20)30152-2

Abstract

Diabetes is one of the most important comorbidities linked to the severity of all three known human pathogenic coronavirus infections, including severe acute respiratory syndrome coronavirus 2. Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure. Depending on the global region, 20-50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes. Given the importance of the link between COVID-19 and diabetes, we have formed an international panel of experts in the field of diabetes and endocrinology to provide some guidance and practical recommendations for the management of diabetes during the pandemic. We aim to briefly provide insight into potential mechanistic links between the novel coronavirus infection and diabetes, present practical management recommendations, and elaborate on the differential needs of several patient groups.

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Figures

**Figure**
Flowchart for metabolic screening and type 1 and 2 diabetes management of patients with COVID-19 Older patients refers to those aged 70 and above. ARDS=Acute Respiratory Distress Syndrom. CGM=Continous Glucose Measurement. FGM=Flash Glucose Measurement. HbA_1c=haemoglobin A_1c. TIR=time in range. *Target concentrations for lower plasma glucose can be adjusted to 5 mmol/l (90 mg/dl) in frail patients. †HbA_1c testing might not be possible at the time, but previous measurements if available allow for differentiation of chronic and acute decompensation.

See this image and copyright information in PMC

Comment in

Guidance on the management of Diabetic Ketoacidosis in the exceptional circumstances of the COVID-19 pandemic.
Rayman G, Lumb A, Kennon B, Cottrell C, Nagi D, Page E, Voigt D, Courtney H, Atkins H, Platts J, Higgins K, Dhatariya K, Patel M, Narendran P, Kar P, Newland-Jones P, Stewart R, Burr O, Thomas S. Rayman G, et al. Diabet Med. 2020 Jul;37(7):1214-1216. doi: 10.1111/dme.14328. Epub 2020 Jun 8. Diabet Med. 2020. PMID: 32421882 Free PMC article. No abstract available.
Management of diabetes in patients with COVID-19.
Lalau JD, Al-Salameh A. Lalau JD, et al. Lancet Diabetes Endocrinol. 2020 Aug;8(8):666-667. doi: 10.1016/S2213-8587(20)30231-X. Lancet Diabetes Endocrinol. 2020. PMID: 32707108 Free PMC article. No abstract available.
Management of diabetes in patients with COVID-19.
Mukherjee JJ, Gangopadhyay KK, Ray S. Mukherjee JJ, et al. Lancet Diabetes Endocrinol. 2020 Aug;8(8):666. doi: 10.1016/S2213-8587(20)30226-6. Lancet Diabetes Endocrinol. 2020. PMID: 32707109 Free PMC article. No abstract available.
Management of diabetes in patients with COVID-19.
Munshi MN, Sy SL. Munshi MN, et al. Lancet Diabetes Endocrinol. 2020 Aug;8(8):667-668. doi: 10.1016/S2213-8587(20)30227-8. Lancet Diabetes Endocrinol. 2020. PMID: 32707110 Free PMC article. No abstract available.
Management of diabetes in patients with COVID-19.
Li A, Harris S, Kariyawasam D, Patel DC, Thomas SM. Li A, et al. Lancet Diabetes Endocrinol. 2020 Aug;8(8):668. doi: 10.1016/S2213-8587(20)30234-5. Lancet Diabetes Endocrinol. 2020. PMID: 32707111 Free PMC article. No abstract available.
Management of diabetes in patients with COVID-19.
Khalangot M. Khalangot M. Lancet Diabetes Endocrinol. 2020 Aug;8(8):669. doi: 10.1016/S2213-8587(20)30235-7. Lancet Diabetes Endocrinol. 2020. PMID: 32707112 Free PMC article. No abstract available.
Management of diabetes in patients with COVID-19 - Authors' reply.
Bornstein SR, Zimmet P, Rubino F, Ludwig B. Bornstein SR, et al. Lancet Diabetes Endocrinol. 2020 Aug;8(8):669-670. doi: 10.1016/S2213-8587(20)30223-0. Lancet Diabetes Endocrinol. 2020. PMID: 32707113 Free PMC article. No abstract available.

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Practical recommendations for the management of diabetes in patients with COVID-19

Affiliations

Practical recommendations for the management of diabetes in patients with COVID-19

Authors

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Abstract

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