COVID-19 in people living with diabetes: An international consensus

Abstract

The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care world-wide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.

Keywords: COVID-19; COVID-19 and diabetes; Consensus; Diabetes; Diabetes complications; Diabetes management.

Fig. 1

COVID-19 and diabetes-related morbidity and mortality.

Fig. 2

The challenges of social distancing in settings with dense population and an informal economy.

Fig. 3

Possible generation and effect of hyperglycemia in COVID-19. Βeta-cells infected by SARS-CoV-2 may reduce insulin secretion. At the same time, the cytokine storm that sometimes accompanies the SARS-CoV-2 infection may induce/worsen insulin resistance. Both conditions may lead to the appearance/worsening of hyperglycemia, which in turn may further induce/worsen insulin resistance. Moreover, hyperglycemia, through the non-enzymatic glycosylation of the ACE2 receptor, may further favor SARS-CoV-2 penetration of cells, worsening the COVID-19. Hyperglycemia, therefore, may induce endothelial dysfunction and thrombus generation, leading to the multi-organ damage characteristic of COVID-19.

Fig. 4

Key diabetes care characteristics before, during, and after the COVID-19 crisis.